BACKGROUND Intensive blood pressure (BP) control in youth with chronic kidney disease (CKD) slows progression, delaying the need for kidney replacement therapy (KRT). Most youth with CKD have hypertension and BP control is difficult to achieve outside of controlled experimental settings. Implementing effective BP control strategies in this population may be cost-saving despite requiring additional resources. Our objective was to determine the economic and clinical impact of intensive versus usual care for BP management in youth with CKD in a microeconomic model. METHODS We developed a decision tree from the US payer perspective to estimate the total costs and clinical effect of an intensified BP intervention over 5 years, modeled after the ESCAPE trial (Effect of Strict Blood Pressure Control and Angiotensin-Converting Enzyme [ACE] Inhibition on Progression of Chronic Renal Failure in Pediatric Patients) protocol. We compared this intervention to usual care in a hypothetical population of youth with mild-to-moderate CKD. Probabilities were informed by published literature; cost estimates were informed by publicly available data. Our outcomes were the net discounted cost of an intensive BP intervention, number needed to treat with the intervention to prevent 1 KRT episode, and incremental cost per KRT episode avoided. RESULTS An intensive BP intervention, with a goal of an average 24-hour mean arterial pressure <50th percentile, improved outcomes with net cost savings of $9440 per participant over 5 years compared with usual care. To prevent 1 episode of KRT over 5 years, 13 participants need to receive intensive BP intervention. CONCLUSIONS Routine use of the ESCAPE protocol for intensive BP control in youth with CKD could save overall costs for the payer and improve clinical outcomes.

中文翻译：

---

慢性肾病青年强化血压控制的成本效益。


背景 慢性肾脏病 （CKD） 青少年的强化血压 （BP） 控制可减缓进展，延迟对肾脏替代疗法 （KRT） 的需求。大多数患有 CKD 的年轻人患有高血压，并且在受控实验环境之外很难实现血压控制。尽管需要额外的资源，但在该人群中实施有效的血压控制策略可能会节省成本。我们的目标是在微观经济模型中确定强化护理与常规护理对 CKD 青年血压管理的经济和临床影响。方法 我们从美国付款人的角度开发了一个决策树，以估计 5 年内强化血压干预的总成本和临床效果，以 ESCAPE 试验 （严格血压控制和血管紧张素转换酶 [ACE] 抑制对儿科患者慢性肾功能衰竭进展的影响）方案为模型。我们将这种干预与假设的轻中度 CKD 青年人群的常规护理进行了比较。概率由已发表的文献提供信息;成本估算以公开可用的数据为依据。我们的结局是强化血压干预的净折扣成本、预防 1 次 KRT 发作所需的干预治疗人数以及避免的每次 KRT 发作的增量成本。结果强化血压干预，目标是平均 24 小时平均动脉压 <50th percentile，改善了结果，与常规护理相比，每位参与者在 5 年内节省了 9440 美元的净成本。为了在 5 年内预防 1 次 KRT 发作，13 名参与者需要接受强化血压干预。 结论 常规使用 ESCAPE 方案对 CKD 青年进行强化血压控制可为支付者节省总体成本并改善临床结局。