Cost-Effectiveness of Behavior Modification Intervention for Patients With Chronic Kidney Disease in the FROM-J Study

Reiko Okubo, Masahide Kondo, Shu Ling Hoshi, Masafumi Okada, Mariko Doi, Hideto Takahashi, Hirayasu Kai, Chie Saito, Kunitoshi Iseki, Chiho Iseki, Tsuyoshi Watanabe, Ichiei Narita, Seiichi Matsuo, Hirofumi Makino, Akira Hishida, Kunihiro Yamagata

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objectives: Chronic kidney disease (CKD) is a significant public health problem. An advanced, or innovative, CKD care system of clinical practice collaboration among general physicians (GPs), nephrologists, and other healthcare workers achieved behavior modification in patients with Stage 3 CKD in the Frontier of Renal Outcome Modifications in Japan (FROM-J) study. This behavior modification intervention consisted of educational sessions on nutrition and lifestyle, as well as encouragement of patients’ regular visits. The intervention contributed to slowing CKD progression. This study aimed to evaluate the cost-effectiveness of the widespread diffusion of the behavior modification intervention proven effective by the FROM-J study. Methods: A cost-effectiveness analysis was carried out to compare the behavior modification intervention with the current practice recommended by the latest CKD clinical guidelines for GPs. A Markov model with a societal perspective under Japan's health system was constructed. We assumed that the behavior modification intervention proven effective by the FROM-J study would be initiated by GPs for targeted patient cohorts—patients aged 40-74 years with Stage 3 CKD—as a part of the innovative CKD care system. Results: The incremental cost-effectiveness ratio for the behavior modification intervention compared with current guideline-based practice was calculated as 145,593 Japanese yen (¥; $1,324 United States dollars [$]) per quality-adjusted life year (QALY). Conclusions: Using the suggested value of social willingness to pay for a one-QALY gain in Japan of ¥5 million (US$45,455) as the threshold to judge cost-effectiveness, the behavior modification intervention is cost-effective. Our results suggest that diffusing the behavior modification intervention proven effective by the FROM-J study could be justifiable as an efficient use of finite healthcare resources. GPs could be encouraged to initiate this intervention by revising the National Health Insurance fee schedule and strengthening clinical guidelines regarding behavior modification interventions.

Original languageEnglish
Pages (from-to)484-493
Number of pages10
JournalJournal of Renal Nutrition
Volume31
Issue number5
DOIs
Publication statusPublished - Sep 2021

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology

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