{"title":"行为矫正干预对慢性肾病患者的成本-效果:FROM-J研究","authors":"Reiko Okubo MD, PhD , Masahide Kondo MD, MSc, PhD , Shu-Ling Hoshi PhD , Masafumi Okada MD, PhD , Mariko Doi PhD , Hideto Takahashi PhD , Hirayasu Kai MD, PhD , Chie Saito MD, PhD , Kunitoshi Iseki MD, PhD , Chiho Iseki PhD , Tsuyoshi Watanabe MD, PhD , Ichiei Narita MD, PhD , Seiichi Matsuo MD, PhD , Hirofumi Makino MD, PhD , Akira Hishida MD, PhD , Kunihiro Yamagata MD, PhD","doi":"10.1053/j.jrn.2020.12.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p><span>Chronic kidney disease<span> (CKD) is a significant public health<span> problem. An advanced, or innovative, CKD care system of clinical practice collaboration among general physicians (GPs), nephrologists, and other healthcare workers achieved behavior modification </span></span></span>in patients with Stage 3 CKD in the Frontier of Renal Outcome Modifications in Japan (FROM-J) study. This behavior modification intervention consisted of educational sessions on nutrition and lifestyle, as well as encouragement of patients’ regular visits. The intervention contributed to slowing CKD progression. This study aimed to evaluate the cost-effectiveness of the widespread diffusion of the behavior modification intervention proven effective by the FROM-J study.</p></div><div><h3>Methods</h3><p>A cost-effectiveness analysis was carried out to compare the behavior modification intervention with the current practice recommended by the latest CKD clinical guidelines for GPs. A Markov model with a societal perspective under Japan’s health system was constructed. We assumed that the behavior modification intervention proven effective by the FROM-J study would be initiated by GPs for targeted patient cohorts—patients aged 40-74 years with Stage 3 CKD—as a part of the innovative CKD care system.</p></div><div><h3>Results</h3><p>The incremental cost-effectiveness ratio for the behavior modification intervention compared with current guideline-based practice was calculated as 145,593 Japanese yen (¥; $1,324 United States dollars [$]) per quality-adjusted life year (QALY).</p></div><div><h3>Conclusions</h3><p>Using the suggested value of social willingness to pay for a one-QALY gain in Japan of ¥5 million (US$45,455) as the threshold to judge cost-effectiveness, the behavior modification intervention is cost-effective. Our results suggest that diffusing the behavior modification intervention proven effective by the FROM-J study could be justifiable as an efficient use of finite healthcare resources. GPs could be encouraged to initiate this intervention by revising the National Health Insurance fee schedule and strengthening clinical guidelines regarding behavior modification interventions.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"31 5","pages":"Pages 484-493"},"PeriodicalIF":3.4000,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"Cost-Effectiveness of Behavior Modification Intervention for Patients With Chronic Kidney Disease in the FROM-J Study\",\"authors\":\"Reiko Okubo MD, PhD , Masahide Kondo MD, MSc, PhD , Shu-Ling Hoshi PhD , Masafumi Okada MD, PhD , Mariko Doi PhD , Hideto Takahashi PhD , Hirayasu Kai MD, PhD , Chie Saito MD, PhD , Kunitoshi Iseki MD, PhD , Chiho Iseki PhD , Tsuyoshi Watanabe MD, PhD , Ichiei Narita MD, PhD , Seiichi Matsuo MD, PhD , Hirofumi Makino MD, PhD , Akira Hishida MD, PhD , Kunihiro Yamagata MD, PhD\",\"doi\":\"10.1053/j.jrn.2020.12.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p><span>Chronic kidney disease<span> (CKD) is a significant public health<span> problem. An advanced, or innovative, CKD care system of clinical practice collaboration among general physicians (GPs), nephrologists, and other healthcare workers achieved behavior modification </span></span></span>in patients with Stage 3 CKD in the Frontier of Renal Outcome Modifications in Japan (FROM-J) study. This behavior modification intervention consisted of educational sessions on nutrition and lifestyle, as well as encouragement of patients’ regular visits. The intervention contributed to slowing CKD progression. This study aimed to evaluate the cost-effectiveness of the widespread diffusion of the behavior modification intervention proven effective by the FROM-J study.</p></div><div><h3>Methods</h3><p>A cost-effectiveness analysis was carried out to compare the behavior modification intervention with the current practice recommended by the latest CKD clinical guidelines for GPs. A Markov model with a societal perspective under Japan’s health system was constructed. We assumed that the behavior modification intervention proven effective by the FROM-J study would be initiated by GPs for targeted patient cohorts—patients aged 40-74 years with Stage 3 CKD—as a part of the innovative CKD care system.</p></div><div><h3>Results</h3><p>The incremental cost-effectiveness ratio for the behavior modification intervention compared with current guideline-based practice was calculated as 145,593 Japanese yen (¥; $1,324 United States dollars [$]) per quality-adjusted life year (QALY).</p></div><div><h3>Conclusions</h3><p>Using the suggested value of social willingness to pay for a one-QALY gain in Japan of ¥5 million (US$45,455) as the threshold to judge cost-effectiveness, the behavior modification intervention is cost-effective. Our results suggest that diffusing the behavior modification intervention proven effective by the FROM-J study could be justifiable as an efficient use of finite healthcare resources. GPs could be encouraged to initiate this intervention by revising the National Health Insurance fee schedule and strengthening clinical guidelines regarding behavior modification interventions.</p></div>\",\"PeriodicalId\":50066,\"journal\":{\"name\":\"Journal of Renal Nutrition\",\"volume\":\"31 5\",\"pages\":\"Pages 484-493\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2021-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Renal Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1051227621000297\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Renal Nutrition","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1051227621000297","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Cost-Effectiveness of Behavior Modification Intervention for Patients With Chronic Kidney Disease in the FROM-J Study
Objectives
Chronic kidney disease (CKD) is a significant public health problem. An advanced, or innovative, CKD care system of clinical practice collaboration among general physicians (GPs), nephrologists, and other healthcare workers achieved behavior modification in patients with Stage 3 CKD in the Frontier of Renal Outcome Modifications in Japan (FROM-J) study. This behavior modification intervention consisted of educational sessions on nutrition and lifestyle, as well as encouragement of patients’ regular visits. The intervention contributed to slowing CKD progression. This study aimed to evaluate the cost-effectiveness of the widespread diffusion of the behavior modification intervention proven effective by the FROM-J study.
Methods
A cost-effectiveness analysis was carried out to compare the behavior modification intervention with the current practice recommended by the latest CKD clinical guidelines for GPs. A Markov model with a societal perspective under Japan’s health system was constructed. We assumed that the behavior modification intervention proven effective by the FROM-J study would be initiated by GPs for targeted patient cohorts—patients aged 40-74 years with Stage 3 CKD—as a part of the innovative CKD care system.
Results
The incremental cost-effectiveness ratio for the behavior modification intervention compared with current guideline-based practice was calculated as 145,593 Japanese yen (¥; $1,324 United States dollars [$]) per quality-adjusted life year (QALY).
Conclusions
Using the suggested value of social willingness to pay for a one-QALY gain in Japan of ¥5 million (US$45,455) as the threshold to judge cost-effectiveness, the behavior modification intervention is cost-effective. Our results suggest that diffusing the behavior modification intervention proven effective by the FROM-J study could be justifiable as an efficient use of finite healthcare resources. GPs could be encouraged to initiate this intervention by revising the National Health Insurance fee schedule and strengthening clinical guidelines regarding behavior modification interventions.
期刊介绍：
The Journal of Renal Nutrition is devoted exclusively to renal nutrition science and renal dietetics. Its content is appropriate for nutritionists, physicians and researchers working in nephrology. Each issue contains a state-of-the-art review, original research, articles on the clinical management and education of patients, a current literature review, and nutritional analysis of food products that have clinical relevance.
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