Project Description

2024 Winner Professor Margaret Kelaher Best PhD Paper Award - Dr Winnie Chen

Biography

Dr Winnie Chen is a clinician-researcher and health economist.

Winnie is completing her PhD with the Territory Kidney Care team at Menzies in Darwin. Her skillsets include health economics (modelled economic evaluations), health informatics (EHR/clinical decision support), and data analysis (Python/R).

Winnie works clinically as a GP at an Aboriginal Medical Service and as a researcher across Menzies in Darwin and University of Sydney. She also teaches medical students at Flinders NT. Previously, she worked as a medical editor (Medical Journal of Australia) and clinical guidelines editor (Northern Territory Primary Health Network).

The Paper

Winnie Chen, Kirsten Howard, Gillian Gorham, Asanga Abeyaratne, Yuejen Zhao, Oyelola Adegboye, Nadarajah Kangaharan, Sean Taylor, Louise J. Maple-Brown, Samuel Heard, Mohammad Radwanur Talukder, Abdolvahab Baghbanian, Sandawana William Majoni, Alan Cass Territory Kidney Care Steering Committee
Cost-Effectiveness of Clinical Decision Support to Improve CKD Outcomes Among First Nations Australians. Kidney International Reports Available online 9 November 2024 https://doi.org/10.1016/j.ekir.2024.10.028

Introduction

The Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support (CDS) tool aims to improve diagnosis and management of CKD in remote NT, particularly among First Nations Australians. We model the cost-effectiveness of the CDS versus usual care.

Methods

Taking a health care funder perspective, we modeled a cohort of people from remote NT at risk of or with CKD, as of January 1, 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017–2023), extrapolated to a 15-year time horizon. The CDS tool was modeled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3).

Results

The remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42 years. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was the least cost-effective. The ICER per quality-adjusted life years (QALYs) gained ranged from $3427 (scenario 3) to $63,486 (scenario 2).

Conclusion

Territory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.