194 the cost-effectiveness of the GoYK intervention, compared to care-as-usual, via a reduction in CKD progression. METHODS We performed a cost-utility analysis of the GoYK intervention, measuring health outcomes in terms of quality-adjusted life years (QALYs) and costs in euros, and extrapolated the results to a lifetime horizon using a Markov model. Details of the methods used are described in the following subsections. COST-EFFECTIVENESS ANALYSIS The cost-effectiveness analysis was performed according to the Dutch guidelines for economic evaluations in healthcare[17]. The GoYK study followed patients and healthcare professionals for nine months, but the effect of the intervention on disease costs and quality of life is expected to increase with time and be more expressive later in life. Therefore, a Markov model was constructed to extrapolate the cost and effects of the GoYK intervention to a lifetime horizon. MODEL STRUCTURE In the Markov model (Figure 6.1), a hypothetical group of 1,000 patients with CKD was followed, either receiving the GoYK intervention or care-as-usual. Patients could progress between four health states: CKD stages 1 or 2 (CKD 1/2), CKD stages 3 or 4 (CKD 3/4), end-stage renal disease (ESRD), and death. These health states mirror the organization of CKD care in the Netherlands, where care for CKD 1/2 is usually provided in primary care, CKD 3/4 in secondary care, and ESRD in dialysis centers. After each cycle, whose length was one year, patients could remain in the same CKD stage, progress to the next CKD stage, or die. We assumed that CKD patients progressed without skipping any stage and that they might die at any time. To match the characteristics of the population of the GoYK study, we used a starting age of 70, with 60% of males, and placed 7.3% of the patients in CKD 1/2 and 92.7% in CKD 3/4. Our analysis was performed from a societal perspective, meaning that it included all relevant societal costs and benefits. In line with Dutch guidelines, costs were discounted at an annual rate of 4% whereas health benefits were discounted at an annual rate of 1.5%[17-19]. The Markov model was constructed using Microsoft Excel 2016 and it was clinically and technically validated by specialists in the areas of Nephrology and Health Economics.
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