Key result
Nurse-led virtual case management for late-stage CKD yields a ~$7339 per-patient break-even point.
Why the study?
Interventions are needed to improve early detection of indications for dialysis in late-stage CKD to reduce suboptimal starts, prevent hospitalizations, and decrease costs.
Does nurse-led virtual case management reduce costs in patients with late-stage CKD at high risk of kidney failure?
Does nurse-led virtual case management reduce costs in patients with late-stage CKD at high risk of kidney failure?
Nurse-led virtual home monitoring interventions in high-risk late-stage CKD patients have the potential for significant cost savings from a health payer perspective.
Answers are grounded in this paper and cite their sources.
May inform payer decisions on virtual CKD management; leaves open randomized confirmation of outcomes and costs.
INTRODUCTION: Interventions are needed to improve early detection of indications for dialysis before development of severe symptoms or complications. This may reduce suboptimal dialysis starts, prevent hospitalizations, and decrease costs. Our objectives were to explore assumptions around a nurse-led virtual case management intervention for patients with late-stage chronic kidney disease (CKD) with a 2-year Kidney Failure Risk Equation (KFRE) estimated risk of kidney failure ≥80% and to estimate how these assumptions affect potential cost savings. METHODS: We performed a cost-minimization analysis by developing a decision analytic microsimulation model constructed from the perspective of the health payer. Our primary outcome was the break-even point, defined as the maximum amount a health payer could spend on the intervention without incurring any net financial loss or gain. The intervention group received remote telemonitoring, including daily measurement of several health metrics (blood pressure, oxygen saturation, and weight), and a validated symptom questionnaire accompanied by nurse-led case management, whereas the comparator group received usual care. We assumed patients received the intervention for a maximum of 2 years. RESULTS: The break-even point was $7339 per late-stage CKD patient enrolled in the intervention. Based on the distribution of time receiving the intervention, we determined a maximum monthly intervention cost of $703.37. In probabilistic sensitivity analyses, we found that 75% of simulations produced break-even points between $3929 and $9460. CONCLUSION: Nurse-led virtual home monitoring interventions in patients with CKD at high risk of kidney failure have the potential for significant cost savings from the perspective of the health payer.
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Ferguson et al. (2020) studied Late-stage chronic kidney disease (CKD). Nurse-led virtual case management and remote telemonitoring vs. Usual care was evaluated on Break-even point (maximum amount a health payer could spend on the intervention without incurring any net financial loss or gain). Nurse-led virtual case management for late-stage CKD yielded a break-even point of $7339 per patient, indicating potential for significant cost savings for health payers.
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