Epidemiologic transition from infectious to noncommunicable diseases (NCDs) in most countries may increase disease and economic burden. Chronic kidney disease (CKD) is a public health problem worldwide. In Colombia, CKD is related to catastrophic health expenses in the overall health care system. The aim of this study is to assess epidemiological and economic impact of CKD in people with risk factors for CKD in Colombia.
A Markov decision model was carried out to estimate the burden of disease of CKD in Colombia. The Markov model have seven states, which followed people with diabetes mellitus (DM) and hypertension from disease onset to 90 years old (in 50 annual cycles). Five states went from CKD stage-1 to CKD stage-5, one transplant state and one absorbing state (death). Parameters were drawn from a literature review. Direct costs were drawn from a sample of patients with end-stage CKD from a large insurer in Colombia between 2009 and 2011. Outcome measures were: cases of CKD, deaths, disability-adjusted life-years (DALYs), and treatment costs.
In Colombia, of 1,899,572 patients with hypertension and DM (62.9% were women), 1,083,735 (57.1%) developed CKD. Of all cohort deaths, 55% were caused by CKD. 4,413 transplants occurred in the cohort. 6.3 millions DALYs are associated to CKD in women, and 10.9 in men, for a total of 17.3 millions. The mean cost per patient with end-stage CKD is around I$20.6 dollars (PPP adjusted). This burden would represent I$45.8 billions dollars (14.1% of estimated Gross Domestic Product of Colombia) if all cases were attended.
Despite limitations, this study shows the increasing economical and disease burden of NCDs in developing countries. This study also highlights the challenge on health systems of increasing aging population and risk factors for NCDs in developing countries such as Colombia.