Abstract
BACKGROUND: Chronic kidney disease (CKD) is a pro- Chronic kidney disease (CKD) is a progressive disease with gressive disease with high societal costs. CKD progresa high societal burden. CKD overlaps with and amplifies the sion is influenced by patients’ health literacy, i.e., the effect of other chronic diseases, resulting in exponentially patients’ ability to deal with information related to their worse health outcomes and costs.1,2 These costs have been own health. growing over the last decades, due to the increasing preva- OBJECTIVE: To assess the cost-effectiveness of Grip on Your Kidneys (GoYK), a multi-component health litlence of CKD and the high cost of therapies.3 Consequently, eracy intervention for CKD patients and their healthcare CKD is among the most expensive diseases for healthcare professionals. systems, with a cost estimated at 140 billion euros annually DESIGN AND MAIN MEASURES: We performed a costin Europe.4 In the Netherlands, the average annual cost per utility analysis of the GoYK intervention, measuring patient can amount to 109,000 euros, when patients reach health outcomes in terms of quality-adjusted life years the more severe stages of the disease.5 Thus, it is imperative (QALYs) and costs in euros, and extrapolated the results to prevent CKD progression, as even small improvements to a lifetime horizon using a Markov model. in renal function could represent large budget savings in the SUBJECTS: The GoYK study was a quasi-experimental study involving 147 patients with CKD and 48 healthlong term.6,7 care professionals from Dutch general practices and Interventions that address low health literacy may pronephrology clinics, followed over nine months. vide a cost-effective solution for slowing CKD progression. KEY RESULTS: We found that the GoYK intervention Health literacy is the degree to which individuals have the would yield a cost-saving of €28,616 and a gain of 0.37 capacity to obtain, process, and understand basic health QALYs per CKD patient across the life course. Moreover, information and services needed to make appropriate health GoYK would avert 31 deaths and 113 new dialyses per decisions.8 Individuals with low health literacy have worse 1,000 patients in the first 10 years. These results mainly stemmed from the intervention effect on the transition to disease management skills, which have been shown to lead end-stage renal disease, where reductions of as little as to faster CKD progression, higher mortality, and higher 1% would already mean GoYK is cost-saving. The intercosts.9,10 Low health literacy also leads to less effective vention remained cost-effective in multiple sensitivity communication between patients and healthcare professionand scenario analyses. als, which has a negative influence on the quality of care.11 CONCLUSIONS: GoYK might be a solution to slow CKD Therefore, interventions focused on health literacy might be progression and, thereby, reduce CKD costs. Given a solution t