Chen, Winnie

Howard, Kirsten

Gorham, Gillian

Abeyaratne, Asanga

Zhao, Yuejen

Adegboye, Oyelola

Kangaharan, Nadarajah

Taylor, Sean

Maple-Brown, Louise

Heard, Samuel

Talukder, Mohammad Radwanur

Baghbanian, Abdolvahab

Majoni, Sandawana William

Cass, Alan

2024-11-09

The Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support (CDS) tool aims to improve diagnosis and management of CKD in remote NT, particularly among First Nations Australians. We model the cost-effectiveness of the CDS versus usual care.Taking a health care funder perspective, we modeled a cohort of people from remote NT at risk of or with CKD, as of January 1, 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017-2023), extrapolated to a 15-year time horizon. The CDS tool was modeled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3).The remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42 years. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was the least cost-effective. The ICER per quality-adjusted life years (QALYs) gained ranged from $3427 (scenario 3) to $63,486 (scenario 2).Territory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Leeder Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.

Leeder Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Northern Territory Health, Darwin, Northern Territory, Australia.

Northern Territory Health, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Division of Medicine, Northern Territory Health, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Northern Territory Health, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Division of Endocrinology, Northern Territory Health, Darwin, Northern Territory, Australia.

Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia.

Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Northern Territory Health, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.

Kidney Int Rep . 2024 Nov 9;10(2):549-564. doi: 10.1016/j.ekir.2024.10.028. eCollection 2025 Feb.

2468-0249

https://pubmed.ncbi.nlm.nih.gov/39990899/?otool=iaurydwlib

https://hdl.handle.net/10137/14162

Aboriginal health

First Nations

chronic kidney disease

clinical decision support

cost

cost-effectiveness

economic evaluation

health economics

health informatics

Cost-Effectiveness of Clinical Decision Support to Improve CKD Outcomes Among First Nations Australians.

Journal Article

Publication