Digital home monitoring versus usual outpatient follow-up in chronic kidney disease: cost-effectiveness of the PROKID randomised non-inferiority trial

Remote patient-reported outcome (PRO) based monitoring may improve efficiency while maintaining clinical outcomes when healthcare systems face increasing pressure due to the rising prevalence of chronic diseases. This study assessed the 18-month cost-effectiveness of PRO-based follow-up interventions compared to usual outpatient follow-up in patients with chronic kidney disease (CKD). Totally, 152 adults with CKD were randomised in a three-arm trial comparing usual outpatient follow-up (control) ( n = 47), PRO-based telephone consultations (PRO-tele) ( n = 54), and PRO-based remote monitoring (PRO-remote) ( n = 51). Cost-effectiveness was evaluated using costs per quality-adjusted life-year (QALY) gained and cost per additional patient meeting the predefined non-inferiority margin for estimated glomerular filtration rate (eGFR). Individual-level healthcare and productivity costs were obtained from national Danish registers. Incremental cost-effectiveness ratios (ICERs) were estimated for each PRO-based intervention versus usual follow-up and between the two interventions, with 500 bootstrap replications to derive confidence intervals. Finally, cost-effectiveness acceptability curves were constructed. During the intervention, mean total costs were €16,664 (control), €19,300 (PRO-tele), and €18,486 (PRO-remote), with similar non-significant increases in median costs from the pre-period (€1,254; €1,104; €1,009). Compared with usual follow-up, PRO-tele showed a small, non-significant QALY gain (0.08; 95% CI: −0.03 to 0.19) at additional costs €1,572 (ICER €19,552/QALY). PRO-remote showed minimal differences in costs (€347) and QALYs (0.01; 95% CI: −0.11 to 0.14), with an ICER of €31,835/QALY. Both interventions had eGFR progression comparable to the control group. Cost-effectiveness acceptability curves indicated approximately 40–70% probability of cost-effectiveness at conventional willingness-to-pay thresholds of €30,000 and €50,000 per QALY gained for both interventions. PRO-based follow-up interventions resulted in comparable QALYs and costs relative to usual outpatient follow-up. The absence of cost savings or significant QALY gains suggests that implementation decisions should also consider non-economic factors, including patient preferences and workflow integration. ClinicalTrial.gov Identifier: NCT03847766 (Retrospectively registered, January 23, 2019).