Economic evaluation of an integrated care program compared to conventional care for chronic kidney disease patients in rural communities of Thailand

Introduction An integrated care program for chronic kidney disease in Thailand has shown its effectiveness in delaying the decline in kidney function, as evidenced by the ESCORT-1 randomized control trial and the ESCORT-2 prospective cohort study. Designed for sustainability within the primary healthcare system, the program optimizes the use of the existing workforce by fostering collaboration among local multidisciplinary care teams and community care networks. Methods A Markov model with a lifetime horizon was used to conduct a cost-utility analysis from a societal perspective. Individual participant level data from ESCORT studies, national registries, and relevant literature were used to estimate model parameters. A budget impact analysis from the payer’s perspective was also assessed over a five-year period. Results The integrated care program yielded a dominant result with 1.84 QALYs gained with “less” lifetime cost, resulting in a negative incremental cost-effectiveness ratio. Probabilistic analysis showed that the intervention being cost-effective almost 100% of the time at the local willingness-to-pay threshold. The intervention maximized cost-effectiveness when delivered as early as possible, both in terms of age and stage. The budget impact analysis estimated that the introduction of the intervention could save about 7% of the Thai government's total health expenditure or 205 billion Thai-Baht ($5.9 billion) over five years with cost savings beginning from the third year onwards. Conclusion The integrated care program for CKD offers potential benefits and cost savings for patients, caregivers, and payers. Future efforts should focus on the screening and implementation processes across various regions and healthcare settings.