Cost-effectiveness of a home-based group educational programme on renal replacement therapies: a study protocol

Abstract

IntroductionLiving donor kidney transplantation (LDKT) is the optimal treatment for most patients with end-stage renal disease (ESRD). However, there are numerous patients who cannot find a living kidney donor. Randomised controlled trials have shown that home-based education for patients with ESRD and their family/friends leads to four times more LDKTs. This educational intervention is currently being implemented in eight hospitals in the Netherlands. Supervision and quality assessment are being employed to maintain the quality of the intervention. In this study, we aim to: (1) conduct a cost-effectiveness analysis of the educational programme and its quality assurance system; (2) investigate the relationship between the quality of the implementation of the intervention and the outcomes knowledge, communication and LDKT activities; and (3) investigate policy implications.Methods and designPatients with ESRD who do not have a living kidney donor are eligible to receive the home-based educational intervention. This is carried out by allied health transplantation professionals and psychologists across eight hospitals in the Netherlands. The cost-effectiveness analysis will be conducted with a Markov model. Cost data will be obtained from the literature. We will obtain the quality of life data from the patients who participate in the educational programme. Questionnaires on knowledge and communication will be used to measure the outcomes of the programme. Data on LDKT activities will be obtained from medical records up to 24 months after the education. A protocol adherence measure will be assessed by a third party by means of a telephone interview with the patients and the invitees.Ethics and disseminationEthical approval was obtained through all participating hospitals. Results will be disseminated through peer-reviewed publications and scientific presentations. Results of the cost-effectiveness of the educational programme will also be disseminated to the Dutch National Health Care Institute.Trial registration numberNL6529

Ethnic background is associated with no live kidney donor identified at the time of first transplant assessment—an opportunity missed? A single‐center retrospective cohort study

“…Studies in the United Kingdom have demonstrated that this may be achieved through informal community networks . In the Netherlands, targeted, culturally competent, home‐based educational programs were effective at improving transplant knowledge and resulted in increased access to LDKT amongst ethnic minorities . Similar home‐based education programs and using culturally competent transplant education in dialysis units improved transplant knowledge and readiness to pursue LDKT for African Americans in the US .…”

A dynamic Markov model to assess the cost-effectiveness of the Kidney Team at Home intervention in The Netherlands

“…Despite differences in the patient population, these studies showed comparable results as the RCT in the USA: an increase in knowledge on all KRTs, better communication on LDKT, and an increase in LDKT-rates. These positive results led to an implementation project in which the Kidney Team at Home program was implemented on a larger scale at eight hospitals in four regions of The Netherlands [ 14 ]. The goal of this program was to assess whether the results of the previous studies could be replicated when the intervention was widely implemented in daily practice.…”

“…Intervention costs were estimated to be €2811 [ 22 ]. This estimation was made based on the implementation project with a micro-costing approach [ 14 ]. All baseline costs were expressed in 2018 Euros.…”

Rapamycin protects against aristolochic acid nephropathy in mice by potentiating mammalian target of rapamycin‑mediated autophagy

“…Autophagy is initiated by lysosomes and can be defined as the process by which intracellular fragments, which are widely present in eukaryotic cells, are degraded (9). In this process, Rapamycin protects against aristolochic acid nephropathy in mice by potentiating mammalian target of rapamycin-mediated autophagy FAN LIN 1,2* , YUNQI LIU 1,3* , LILI TANG 4 , XIAOHUI XU 2 , XUELI ZHANG 2 , YIFAN SONG 2 , BICHENG CHEN 5 , YEPING REN 2 and XIANGDONG YANG 1 damaged organelles and misfolded proteins are phagocytized to form autophagosomes, which then fuse with lysosomes to form autolysosomes. These degrade autophagosomes and ensure dynamic cell balance (10).…”

“…A multicenter retrospective cohort study in China showed that the incidence of acute renal injury was 11.6% among nearly 660,000 hospitalized patients, of which 40% was drug-induced and 16% may have been caused by Chinese herbal medicine and plants containing AA ( 3 ). A considerable proportion of patients with AAN have impaired renal function and progress to end-stage renal disease (ESRD) ( 4 ). Patients with ESRD require long-term renal replacement therapy, which necessitates a large number of medical resources.…”