NDT Advance Access originally published online on June 5, 2007
Nephrology Dialysis Transplantation 2007 22(9):2504-2512; doi:10.1093/ndt/gfm248
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The cost of implementing UK guidelines for the management of chronic kidney disease
1Department of Renal Medicine, Kent and Canterbury Hospital, East Kent Hospitals NHS Trust, Ethelbert Road, 2Computing Laboratory, University of Kent, Canterbury, Kent CT2 7NF, 3Department of Renal Medicine, Hope Hospital, Stott Lane, Salford, Greater Manchester, M6 8HD, UK, 4Primary Care Informatics, Division of Community Health Sciences, Hunter Wing, St George's—University of London, London SW17 0RE, 5Department of Clinical Biochemistry, Kent and Canterbury Hospital, East Kent Hospitals NHS Trust, Ethelbert Road, Canterbury, Kent CT1 3NG and 6Department of Diabetes, Hope Hospital, Stott Lane, Salford, Greater Manchester, M6 8HD, UK
Correspondence and offprint requests to: Christopher K. T. Farmer, Department of Renal Medicine, Kent and Canterbury Hospital, East Kent Hospitals NHS Trust, Ethelbert Road, Canterbury, Kent CT1 3NG, UK. Email: Chris.Farmer{at}ekht.nhs.uk
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Abstract |
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Background. Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases.
Methods. We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed.
Results. In the first year, a practice of 10 000 would identify 147.5 patients with stages 3–5 CKD over and above those already known. All stages 4–5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline 
5 ml/min/1.73 m2/year, 1.11 with haemoglobin <11 g/dl and 1.67 with blood pressure >150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was 
6111; and 7836 for nephrology referral. Total costs of 17 133 in the first year were increased to 29 790 through the effect of creatinine calibration.
Conclusions. CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10 000 patients managed according to guidelines.
Keywords: cardiovascular risk; chronic kidney disease; cost analysis; glomerular filtration rate; guidelines; referral
Received for publication: 12.10.06
Accepted in revised form: 30. 3.07
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