Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England

Abstract

Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Individuals with more severe CKD had lower HRQoL compared to those with better kidney function. Compared to those with normal/low normal kidney function and stage 1 CKD, those with stage 2, stage 3 with albuminuria and stage 4/5 CKD experienced a decrement of 0.11, 0.18 and 0.28 in their utility index, respectively. Applying the UK reimbursement threshold for a QALY, the monetised lifetime burden of reduced HRQoL due to stage 2, stage 3 with albuminuria and stage 4/5 CKD were £103,734; £83,399; £125,335 in males and £143,582; £70,288; £203,804 in females, respectively. Utilizing the predicted prevalence of CKD among individuals with diabetes mellitus, the economic burden of CKD per million of individuals with diabetes is forecasted at approximately £11.4 billion in 2025. In conclusion, CKD has a strong adverse impact on HRQoL in multiple domains. The estimated economic burden of CKD among individuals with diabetes mellitus in the UK is projected to rise markedly over time.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The proportion of respondents reporting any problems in each domain of EQ-5D questionnaire.

Note: Stage 3(i): Stage 3 CKD with albuminuria, Stage 3(ii): Stage 3 CKD without albuminuria.

Fig 2. Multivariable Tobit model exploring the relationship between CKD severity and HRQoL (the base case model).

Note: †: Income2 (>£11,142.86 & ≤£19,090.91), Income3 (>£19,090.91 & ≤£29,166.67), Income4 (>£29,166.67 & ≤£45,138.89), Income5 (>£45,138.89); (i) Stage 3 CKD without albuminuria, (ii) Stage 3 CKD with albuminuria. Bar represents 95% Confidence Intervals (CI), Dot represents the coefficient of the multivariable Tobit model.

Fig 3. Projected economic burden of stages 3–5 CKD from 2012 up to 2025 in the UK.

pmp: per million diabetic population. Line represents the prediction economic burden per million diabetic population from 2012 up to 2025; the dark area represents 95% Confidence Intervals (CI).