Cost Effectiveness of Preventing and Managing Chronic Kidney Disease in Hong Kong via Microsimulation
Description: Introduction
Chronic kidney disease (CKD) can be primarily prevented through lifestyle modifications and secondarily prevented via early detection and timely initiation of triple therapy (3Tx) comprising an ACE inhibitor (ACEi), SGLT2 inhibitor, and mineralocorticoid receptor antagonist (MRA) for diabetic patients.
Aims
This study aims to quantify the incremental costs and quality-adjusted life years (QALYs) gained in a Hong Kong cohort aged 35 to 80 by:
1. Enhancing screening for microalbuminuria at primary intake in Hong Kong district health centres (DHCs).
2. Improving follow-up on referrals to increase the proportion of patients receiving guideline-compliant care.
3. Implementing digitally enhanced lifestyle change guidance.
Methods
Form a synthetic cohort of 4 million Hong Kong residents age 40 to 79. Each simulated person (SP) is represented as a vector of biomarker values, including systolic blood pressure (sBP), hemoglobin A1C (HGBa1c), microalbuminuria, and glomerular filtration rate (GFR). Medical histories will track visits to DHCs and GPs, compliance with exercise and diet, use of 3Tx medications, hospitalization and dialysis costs, and survival. Annually, biomarker values and other parameters will update stochastically. The model will assess the proportion of individuals screened, receiving medications, and adopting lifestyle changes, and how these interventions influence biomarker trajectories. Stochastic parameters will be derived from literature and Hong Kong Hospital Authority data. Sensitivity analyses will estimate uncertainty ranges. The three aims will be evaluated by modeling their quantitative impact and tracking lifetime discounted healthcare costs. Policy impact will be ensured by engaging health department and Hospital Authority policymakers in interpreting results.
Funder: Health and Medical Research Fund
Amount: HKD 1,127,000
Funding type: grant
Funder scheme: HMRF - Health and Health Services (including HHSRF)
Start date: 2024-01-01
Investigator: David BISHAI
Institution: School of Public Health, The University of Hong Kong
Funded outputs count: 0
Funder award ID: 23242871
OpenAlex ID: G2989323105