The Cost and Outcomes of Using Multidisciplinary Care Program in the Care of Adult Patients with Advanced Chronic Kidney Disease.

Abstract

Objective: The aim of the study was to compare the direct healthcare cost and outcomes of a multidisciplinary care (MDC) program versus usual care for patients with advanced chronic kidney disease (CKD) in Singapore.

Methods: A retrospective study of patients with an estimated glomerular filtration rate (eGFR) less than 20 mL/min/1.73 m2, attending the MDC program or the usual care clinic in a tertiary hospital from 2016 to 2019. The usual care group was matched to the MDC group using propensity score matching based on age, gender, baseline eGFR, and diabetes mellitus. The primary outcome was the rate of emergent long-term kidney replacement therapy (KRT) initiation and the direct healthcare cost incurred from eGFR for less than 20 mL/min/1.73 m2 for the initiation of long-term KRT.

Results: There were 280 patients in each group. The MDC group had a lower rate of emergent KRT initiation than the usual care group (33.3 vs. 55.7 events per 100 patient-year, p = 0.003), shorter length of hospitalization stay (8.0 vs. 16.5 days per year, p = 0.004), lower number of emergency department visits (0.7 vs. 1.2 visits per year, p = 0.005), and higher number of renal clinic visits (14.5 vs. 13.0 visits per year, p = 0.009). The healthcare cost was lower in the MDC group than in the usual care group (SGD USD 18,408.83 (USD 13,664.51) vs. SGD USD 28,734.43 (USD 21,329.00) per patient-year, p = 0.016).

Conclusion: The MDC program for patients with advanced CKD in Singapore was associated with lower rate of emergent KRT initiation, shorter hospitalization stay, lower number of emergency department visit, and lower healthcare cost.