Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England

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Abstract

Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Individuals with more severe CKD had lower HRQoL compared to those with better kidney function. Compared to those with normal/low normal kidney function and stage 1 CKD, those with stage 2, stage 3 with albuminuria and stage 4/5 CKD experienced a decrement of 0.11, 0.18 and 0.28 in their utility index, respectively. Applying the UK reimbursement threshold for a QALY, the monetised lifetime burden of reduced HRQoL due to stage 2, stage 3 with albuminuria and stage 4/5 CKD were £103,734; £83,399; £125,335 in males and £143,582; £70,288; £203,804 in females, respectively. Utilizing the predicted prevalence of CKD among individuals with diabetes mellitus, the economic burden of CKD per million of individuals with diabetes is forecasted at approximately £11.4 billion in 2025. In conclusion, CKD has a strong adverse impact on HRQoL in multiple domains. The estimated economic burden of CKD among individuals with diabetes mellitus in the UK is projected to rise markedly over time.

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Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes.

A S Levey, R. Atkins, J Coresh … (2007)

Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease, and reduce the risk of cardiovascular disease (CVD). Translating these advances to simple and applicable public health measures must be adopted as a goal worldwide. Understanding the relationship between CKD and other chronic diseases is important to developing a public health policy to improve outcomes. The 2004 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference on 'Definition and Classification of Chronic Kidney Disease' represented an important endorsement of the Kidney Disease Outcome Quality Initiative definition and classification of CKD by the international community. The 2006 KDIGO Controversies Conference on CKD was convened to consider six major topics: (1) CKD classification, (2) CKD screening and surveillance, (3) public policy for CKD, (4) CVD and CVD risk factors as risk factors for development and progression of CKD, (5) association of CKD with chronic infections, and (6) association of CKD with cancer. This report contains the recommendations from the meeting. It has been reviewed by the conference participants and approved as position statement by the KDIGO Board of Directors. KDIGO will work in collaboration with international and national public health organizations to facilitate implementation of these recommendations.

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The global burden of chronic kidney disease: estimates, variability and pitfalls

Richard Glassock, David Warnock, Pierre Delanaye (2016)

Chronic kidney disease (CKD) is currently defined by abnormalities of kidney structure or function assessed using a matrix of variables — including glomerular filtration rate (GFR), thresholds of albuminuria and duration of injury — and is considered by many to be a common disorder globally.

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Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available.

John Brazier, Roberta Ara (2011)

Decision analytic models in health care require baseline health-related quality of life data to accurately assess the benefits of interventions. The use of inappropriate baselines such as assuming the value of perfect health (EQ-5D = 1) for not having a condition may overestimate the benefits of some treatment and thus distort policy decisions informed by cost per quality adjusted life years thresholds. The primary objective was to determine if data from the general population are appropriate for baseline health state utility values (HSUVs) when condition specific data are not available. Data from four consecutive Health Surveys for England were pooled. Self-reported health status and EQ-5D data were extracted and used to generate mean HSUVs for cohorts with or without prevalent health conditions. These were compared with mean HSUVs from all respondents irrespective of health status. More than 45% of respondents (n = 41,174) reported at least one condition and almost 20% reported at least two. Our results suggest that data from the general population could be used to approximate baseline HSUVs in some analyses, but not all. In particular, HSUVs from the general population would not be an appropriate baseline for cohorts who have just one condition. In these instances, if condition specific data are not available, data from respondents who report they do not have any prevalent health condition may be more appropriate. Exploratory analyses suggest the decrement on health-related quality of life may not be constant across ages for all conditions and these relationships may be condition specific. Additional research is required to validate our findings. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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Contributors

Nga T. Q. Nguyen:

ORCID: http://orcid.org/0000-0001-9843-4410

Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Paul Cockwell: Role: Writing – review & editing

Alexander P. Maxwell: Role: Writing – review & editing

Matthew Griffin: Role: Writing – review & editing

Timothy O’Brien: Role: Writing – review & editing

Ciaran O’Neill: Role: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – review & editing

Davide Bolignano: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 26 November 2018

Publication date Collection: 2018

Volume: 13

Issue: 11

Electronic Location Identifier: e0207960

Affiliations

[1 ] Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom

[2 ] University Hospitals Birmingham, Birmingham, United Kingdom

[3 ] National University of Ireland Galway, Galway, Ireland

Consiglio Nazionale delle Ricerche, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

‡ These authors also contributed equally to this work.

* E-mail: nnguyen05@ 123456qub.ac.uk

Author information

Nga T. Q. Nguyen http://orcid.org/0000-0001-9843-4410

Article

Publisher ID: PONE-D-18-28814

DOI: 10.1371/journal.pone.0207960

PMC ID: 6258125

PubMed ID: 30475893

SO-VID: 68feece3-8a7f-4d60-ae3c-a1f30f542d6c

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 3 October 2018

Date accepted : 8 November 2018

Page count

Figures: 3, Tables: 2, Pages: 12

Funding

This research is based upon work supported by the Health Research Board research grant RL/2013/16 and Vietnam International Education Development (VIED). This research has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634086 (‘NEPHSTROM’). The material presented and views expressed here are the responsibility of the author(s) only. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England

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Most cited references 15

Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes.

The global burden of chronic kidney disease: estimates, variability and pitfalls

Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available.

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