PhD defence S. (Steef) Redeker

Summary:

The effectiveness of home-based educational interventions for patients with end-stage kidney disease, to improve living donor kidney transplantation has been shown in previous RCTs in the Rotterdam transplant area, the ‘Nierteam aan Huis’ intervention. In 2016, an implementation project started throughout the Netherlands, to assess the feasibility of implementation into standard care. The results were favorable; a considerable number of patients underwent a transplantation after the educational intervention, at relatively low costs. 
Another important step for national implementation was to assess the cost-effectiveness of the intervention. With a Markov Model we evaluated the costs and effects of a setting with ánd without the intervention. These results were also favorable; it is expected that implementation of the intervention will result in more (quality adjusted) life years, at lower societal costs. Thus, making the intervention beneficial for society and patient.
These results resulted in uptake of the intervention into standard-care. However, during the implementation project it became evident that there are certain (financial) incentives that promotes the use of center dialysis, at the expense of home dialysis and living donor kidney transplantation. This is remarkable, as these latter treatments are associated with higher quality of life and survival. This indicates the presence of supplier-induced demand. To overcome this, we argue that by reducing the number of center dialysis beds, overall care for patients with end-stage kidney disease will improve.