Economic Analysis of a Ketoanalogue-supplemented Very Low-protein Diet in Patients With Chronic Kidney Disease in Vietnam

• Published in: Clinical therapeutics Vol. 45; no. 7; pp. 649 - 654
• Main Authors: Huynh, Thao Ngoc Phuong, Nguyen, Tuan Minh, Povero, Massimiliano, Pradelli, Lorenzo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2023; Elsevier Limited
• Subjects: Amino acids; Chronic kidney disease; Clinical medicine; Clinical trials; Cost analysis; Cost-effectiveness; Dialysis; Diet; Dietary management; Dietary restrictions; Economic analysis; Global health; Health care expenditures; Health care policy; Hemodialysis; Ketoanalogue-supplemented VLPD; Kidney diseases; Kidneys; Life span; Literature reviews; Low protein diet; Markov chains; Mortality; Nitrogen; Nutrient deficiency; Patients; Peritoneal dialysis; Protein reduced diet; Proteins; Sensitivity analysis; Societal perspective; Transition probabilities; Vietnam; Protein reduced diet; Chronic kidney disease; Societal perspective; Dietary management; Cost-effectiveness; Ketoanalogue-supplemented VLPD
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2023.05.008

The aim of this study was to estimate the cost-effectiveness of a very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids compared with a conventional low-protein diet (LPD) in Vietnam. The study was conducted from payer (base case), patient, and societal perspectives. A Markov model simulated costs and quality-adjusted life-years (QALYs) for patients with chronic kidney disease stage 4 or 5 (CKD4+) who were followed up during their lifetimes. Patients received a VLPD (0.3- to 0.4-g/kg/d diet) supplemented with ketoanalogues (5 kg/d [1 tablet]) versus LPD (0.6 g/kg/d, mixed proteins). In each model cycle, patient transitions among the health states—CKD4+ (nondialysis), dialysis, and death—were based on transition probabilities taken from the published literature. The time horizon covered the cohort's lifetime. Utilities and costs were estimated from literature review and projected for the lifespan considered in the model. Probabilistic and deterministic sensitivity analyses were performed. The ketoanalogue-supplemented VLPD increased survival and QALYs compared with the LPD. From a payer's perspective, total cost of care in Vietnam was ₫216,854,268 (€8684/$9242) per patient with LPD versus ₫200,928,819 (€8046/$8563) per patient with a supplemented VLPD (sVLPD) (difference, −₫15,925,449 [−€638/−$679]). From a patient's perspective, total cost of care in Vietnam was ₫217,872,043 (€8724/$9285) per patient with LPD versus ₫116,015,672 (€4646/$4944) per patient with sVLPD (difference, -₫101,856,371 [−€4,079/ −$4341]). From a societal perspective, total cost of care in Vietnam was ₫434,726,312 (€17,408/−$18,527) per patient with LPD versus ₫316,944,491 (€12,692/ $13,508) per patient with sVLPD (difference, -₫117,781,820 [−€4716 €/$5020). Ketoanalogue-supplemented VLPD lowered costs compared with LPD in all 3 perspectives considered.