Cost-effectiveness of multidisciplinary care for patients with chronic kidney disease in Japan

BACKGROUND: Multidisciplinary care (MDC), where a team of various health professionals provides guidance to patients, is an effective approach for chronic kidney disease (CKD) and has been reimbursed by Japanese public healthcare insurance in 2024. To sustainably achieve medical benefits with limited resources, we examined the cost-effectiveness of MDC in Japan. METHODS: A Markov model from a healthcare system perspective was used to evaluate the cost-effectiveness of adding MDC to the standard treatment for CKD in Japan over lifetime. Each cohort with an initial CKD stage (G3a, G3b, and G4) was analyzed. The parameters were based on previous studies including Chronic Kidney Disease Japan Cohort study. An incremental cost-effectiveness ratio (ICER) of < 5,000,000 Japanese yen (JPY) per quality-adjusted life-year (QALY) was considered cost-effective. One-way deterministic analyses, probabilistic sensitivity analyses, and scenario analyses were conducted to ensure the robustness of the results. RESULTS: Adding MDC to the standard treatment for CKD decreased cost by 10.66 million, 8.42 million, 4.21 million JPY and increased utility by 9.52, 8.70, 7.17 QALYs in CKD G3a, G3b, and G4 cohort, respectively, suggesting that it was a dominant strategy. Sensitivity analyses showed that adding MDC was cost-effective in more than 99% of cases in all cohorts with an ICER threshold of 5,000,000 JPY. Scenario analyses, where smaller therapeutic effects of MDC were estimated, showed compatible results. CONCLUSION: Based on our model, adding MDC to the standard treatment for CKD stages G3a, G3b, and G4, is highly likely to be a cost-effective strategy in Japanese healthcare system.