Public health interventions for chronic diseases: cost–benefit modelizations for eradicating chronic kidney disease of multifactorial origin (CKDmfo/ CKDu) from tropical countries

Abstract

Background: In the mid-1970s, an unusual chronic kidney disease of multifactorial origin (CKDmfo), also known as CKD of unknown aetiology (CKDu), began to manifest in several economically poor, tropical, agricultural countries. This preventable, environmentally induced, occupational disease affects several peri-equatorial countries; it first manifested in Sri Lanka in the mid-1990s. The study goal was to estimate the costs of eradicating CKDmfo and the resulting cost savings, using CKDmfo in Sri Lanka as an example. This chronic disease model is applicable to CKDu and few other chronic diseases in other countries. Methodology: Eight cost-effective, key interventions were identified that are essential to eradicate CKDmfo. A systematic assessment was performed on these interventions (including providing clean water, behavioural and lifestyle changes, alleviating malnutrition, reducing irresponsible and overuse of agrochemicals, and cost-effective treatment options), the cost of prevention, and the resultant cost savings. A cost-benefit analysis was based on the data collected during the past 20 years of work in Sri Lanka. Findings: The yearly cost required to eradicate the disease was approximately one-tenth of the current annual operating and opportunity costs due to CKDmfo. Analysis indicates that implementation of a focussed chronic disease-prevention plan using essential multiple interventions, CKDmfo can be eradicated within 15 years. This includes provision of potable water; real-time disease surveillance program; public and professional education; prevention of environmental pollution; alleviation of poverty and associated malnutrition; sustainable self-sufficiency in food, clean water, energy, and security; diversification of economy and job opportunities; sustainable economic development; regionwide programs of effective screening, early diagnosis and intervention to reverse the disease progression at earliest possible; and effective treatment of CKDmfo. Interpretation: This analysis is based on multiple population-level, chronic disease-eradication strategies that include an interdisciplinary, geographic information system (GIS)-based, regionwide, long-term research and intervention program; economic diversification; and environmental, socioeconomic, and behavioural improvements. Such an approach will facilitate identification of root causes and key risk factors, enabling implementation of cost-effective longer-term interventions to eradicate chronic diseases, applicable to other countries as well.

Global Perspectives on Improving Chronic Disease Prevention and Management in Diverse Settings

“…The goal of the collection is to assemble recently published articles that focus on innovative and effective strategies to improve chronic disease outcomes in diverse populations globally. As efforts to improve global health have accelerated in response to achieving sustainable development goals, chronic disease continues to be a major contributor to poor health outcomes, which often lead to reduction in quality of life, including associated increases in health care costs ( 19 , 20 ). Reducing the burden of chronic diseases remains a global challenge, requiring collaborations across academic disciplines and economic sectors.…”

Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review

“…Eradicating CKDu through proper disease prevention programs, medicine, and healthcare collectively with efficient diagnosis is crucial (Chung et al 2015 ; Wimalawansa 2019 ). CKDu can be eradicated within 15 years by implementing a focused chronic disease prevention plan and by using essential interventions (Wimalawansa 2019 ) .…”

Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings

“…Proposed causes of CKDmfo include agrochemicals; fungi, algae, and microbial toxins; viruses and spirochetes; heavy metals (HMs); high-fructose diets; heat stress and chronic dehydration (due to excessive sweating, reduced water intake because of unpalatable hard water, and daily ingestion of illicitly brewed alcohol); abuse of non-steroidal anti-inflammatory agents [35]. Exposure to high doses of some of the above have been shown to cause acute renal failure with associated renal damage that can lead to chronic renal failure [36,37].…”