Abstract: TH-PO1010
Evaluating the Clinical, Socioeconomic, and Environmental Impact of Guideline-Directed Therapy in the United States: An IMPACT CKD Analysis
Session Information
- CKD: Epidemiology, Risk Factors, and Prevention - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
- Wyman, Cole, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
- Rao, Naveen, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
- Chen, Jieling, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, United States
- Priest, Stacey, EVERSANA, Burlington, Ontario, Canada
- Brown, Stephen, EVERSANA, Burlington, Ontario, Canada
- Cases, Aleix, Hospital Clinic de Barcelona, Barcelona, Spain
- Chadban, Steven J., Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
Background
Chronic kidney disease (CKD) is underdiagnosed and undertreated in the United States (US) despite evidence that therapies can delay disease progression and reduce clinical events. This study aims to illustrate the impact of improved adherence to therapies recommended for patients with CKD (i.e., guideline-directed medical therapy [GDMT]) on clinical, socioeconomic, and environmental outcomes to inform policy decisions.
Methods
The US population was simulated for 25-years (baseline: 2022; simulated years: 2023-2047) using the IMPACT CKD model. Two scenarios were compared: 75% adherence to GDMT vs. current practice as observed. GDMT included glucose and lipid lowering, antihypertensive, and lifestyle interventions. It was assumed that patients diagnosed with CKD could be treated with multiple therapies per guideline eligibility and that there would be no changes to guidelines or CKD detection rate over the time horizon. Treatment effects on estimated glomerular filtration rate (eGFR) decline, cardiovascular events, and acute kidney injury (AKI) events were assumed to be multiplicative.
Results
Improved adherence to GDMT was associated with a 32% decrease in dialysis due to delayed disease progression. Reductions were projected in myocardial infarction, stroke, hospitalized heart failure, AKI, and death by 21%, 17%, 24%, 9%, and 5%, respectively. Renal replacement therapy (RRT) and total CKD costs were projected to decrease by 25% and 5%, respectively. Freshwater consumption, fossil fuel depletion, and carbon emissions due to RRT were also projected to decrease by 28%. Furthermore, reductions in disease progression and death also contributed to improvements in projected net workdays, gross domestic product, full-time equivalents, and tax revenue among employed patients and caregivers. The benefits of improved adherence to GDMT were seen after six years. Similar trends were observed with a 10-year time horizon but with smaller magnitude.
Conclusion
This study predicted significant clinical, socioeconomic, and environmental benefits with improved adherence to GDMT. These findings underscore the importance of policy action to improve adherence and actualize the potential of effective therapies to mitigate CKD burden.
Funding
- Commercial Support – AstraZeneca