193 INTRODUCTION Chronic kidney disease (CKD) is a progressive disease with a high societal burden. CKD overlaps with and amplifies the effect of other chronic diseases, resulting in exponentially worse health outcomes and costs[1,2]. These costs have been growing over the last decades, due to the increasing prevalence of CKD and the high cost of therapies[3]. Consequently, CKD is among the most expensive diseases for healthcare systems, with a cost estimated at 140 billion euros annually in Europe[4]. In the Netherlands, the average annual cost per patient can amount to 109,000 euros, when patients reach the more severe stages of the disease[5]. Thus, it is imperative to prevent CKD progression, as even small improvements in renal function could represent large budget savings in the long term[6,7]. Interventions that address low health literacy may provide a cost-effective solution for slowing CKD progression. Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions[8]. Individuals with low health literacy have worse disease management skills, which have been shown to lead to faster CKD progression, higher mortality, and higher costs [9,10].Low health literacy also leads to less effective communication between patients and healthcare professionals, which has a negative influence on the quality of care[11]. Therefore, interventions focused on health literacy might be a solution to improve CKD care and, thereby, mitigate CKD progression and CKD burden. Fortunately, such interventions are likely to be cost-effective, due to the minimal costs of this approach[12-14]. To the best of our knowledge, however, health-economic studies of health-literacy-tailored interventions in CKD still do not exist. We developed and tested the Grip on Your Kidneys (GoYK) intervention, a multi-component health literacy intervention for CKD patients and healthcare professionals[15]. During a nine-month follow-up, when compared to care-asusual, the group of patients that received the intervention showed improvements in levels of hypertension[15]. Given that hypertension is associated with CKD[16], we hypothesized that the GoYK intervention may have a protective effect on CKD progression, thereby reducing costs. Thus, the present study aimed to investigate
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