Early referral strategies for patients with markers of renal disease

Early referral strategies for patients with markers of renal disease

Improved management of Chronic Kidney Disease (CKD) can improve survival outcomes in those who do develop end stage renal disease. This has led to calls for patients to be referred to specialists at an early stage in the disease process. However, little evidence exists on the effectiveness and cost-effectiveness of such approaches compared with historical practice (referral upon development of ESRD). This project systematically reviewed the existing literature and developed an economic model, to investigate early versus later referral. The study found that an early referral model, combining some form of shared care between primary and secondary care, has the potential to be cost-effective. However, the evidence base has significant limitations and there are key areas of uncertainty.

Outcome and Translation

This study recommended to the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme that a future randomised controlled trial with economic outcomes should be conducted to reduce decision uncertainty.

HERU researchers involved in this research project: Paul McNamee and Graham Scotland

External Collaborators: C Black, C Smith and A McLeod (Division of Applied Health Sciences, University of Aberdeen)

Publications

Black, C., Sharma, P., Scotland, G., McCullough, K., McGurn, D., Robertson, L., Fluck, N., MacLeod, A., McNamee, P., Prescott, G. and Smith, C. (2010) 'Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis', Health Technology Assessment, 14(21).

Sharma, P., McCullough, K., Scotland, G., McNamee, P., Prescott, G., MacLeod, A., Fluck, N., Smith, W.C. and Black, C. (2010) 'Does stage-3 chronic kidney disease matter? A systematic literature review', British Journal of General Practice, 60(575), 442-448.

Scotland, G. (2011) 'Economic evaluation of an early referral strategy for people with chronic kidney disease', HERU Briefing Paper, University of Aberdeen, February 2011.

Presentations

Black, C., Sharma, P., Scotland, G., McCullough, K., McGurn, D., Robertson, L., Fluck, N., MacLeod, A., McNamee, P., Prescott, G. and Smith, C. (2009) 'Early referral for chronic kidney disease: the evidence and economic case', American Nephrology Association, San Diego, November 2009.

Sharma, P., Black, C., Scotland, G., McCullough, K., Robertson, L., Fluck, N., Macleod, A. M., McNamee, P., Prescott, G. and Smith, W. C. (2010) 'Approaches to care in Chronic Kidney Disease: supporting the development of a health economics model', 7th Annual Health Technology Assessment International, Dublin, June 2010.

Sharma, P., Black, C., Scotland, G., McCullough, K., Robertson, L., Fluck, N., Macleod, A. M., McNamee, P., Prescott, G. and Smith, W. C. (2010) 'The building blocks for complex decision making: an example of HTA in chronic kidney disease care', 7th Annual Health Technology Assessment International, Dublin, June 2010.