Marco Boonstra

197 Quality of life (utilities) We assigned utility indexes, in QALYs, to each CKD stage (Table 6.1). The effect of GoYK on QALY gains was based on the difference in CKD-stage distribution induced by the intervention. CKD 3/4 was assigned a utility index based on the results of the baseline EQ-5D questionnaire applied to participants during the GoYK study. Given that the GoYK study did not assess ESRD patients and had too few patients in CKD 1/2, the utility scores for these stages were obtained from the literature[29,30]. Costs Direct medical costs for ESRD were obtained from literature[5], assuming all patients in ESRD need hemodialysis. The costs specific to CKD 1/2 and CKD 3/4 have not been evaluated in the Netherlands, so we calculated them based on general non-dialysis CKD costs and on the costs of the main CKD treatment targets in the Netherlands[37], namely diabetes, hypertension, and cardiovascular disease. The difference in costs between CKD 1/2 and CKD 3/4 corresponded, therefore, to the difference in the prevalence of those treatment targets in each CKD stage. The prevalence of each disease in CKD 3/4 was derived from the GoYK study. The prevalence for CKD 1/2 could not be derived from the GoYK study, given that it only included a few participants in these stages, so we used data from the general population registered in GP practices in the Netherlands[21]. This calculation led to costs comparable to those from neighboring countries[38]. Indirect medical costs were obtained from a Dutch registry[36] and included as a sensitivity analysis. Non-medical costs, collected in the GoYK study, did not differ between groups and were not included in the Markov model. GoYK costs regarded the development, implementation, and maintenance of the intervention. They regarded the development of digital and paper material, printing fees, website domain license, workshops for healthcare professionals, promotion of the intervention, and the hiring of a GoYK manager and educator, who would be responsible for periodically updating the intervention, giving workshops, managing marketing, and other administrative functions related to the implementation and maintenance of the intervention. We assumed the

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