Inside CKD aims to assess the burden of chronic kidney disease (CKD) and the cost-effectiveness of screening programmes in Belgium.

Microsimulation-based modelling.

Data derived from national statistics and key literature from Belgium.

Virtual populations of ≥10 million individuals, representative of Belgian populations of interest, were generated based on published data and cycled through the Inside CKD model. Baseline input data included age, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR) and CKD status.

Outcomes included the clinical and economic burden of CKD during 2022–2027 and the cost-effectiveness of two different CKD screening programmes (one UACR measurement and two eGFR measurements or only two eGFR measurements, followed by renin-angiotensin-aldosterone system inhibitor treatment in newly diagnosed eligible patients). The economic burden estimation included patients diagnosed with CKD stages 3–5; the screening cost-effectiveness estimation included patients aged ≥45 years with no CKD diagnosis and high-risk subgroups (with cardiovascular disease, hypertension, type 2 diabetes or aged ≥65 years).

Between 2022 and 2027, CKD prevalence is estimated to remain stable and substantial at approximately 1.66 million, with 69.9% undiagnosed. The total healthcare cost of patients diagnosed with CKD is expected to remain stable at approximately 2.15 billion per year. The one UACR, two eGFR measurement screening programme was cost-effective in all populations, with an incremental cost-effectiveness ratio of 3623 per quality-adjusted life year (QALY) gained in those aged ≥45 years, well below the estimated willingness-to-pay threshold of 43 839 per QALY gained.

Without changes to current practice, the disease burden of CKD in Belgium is predicted to remain substantial over the next few years. This highlights the need for timely diagnosis of CKD and demonstrates that, in line with guideline recommendations, implementing a CKD screening programme involving UACR and eGFR measurements followed by treatment would be cost-effective.

Heart failure is an important health problem and patients are generally older with several comorbidities. Multidisciplinary heart failure care is therefore recommended. However, there is little evidence in real-world settings on how to involve primary care health professionals and how to evaluate such programmes. The main objective of this study is to integrate and evaluate several disease management interventions in a primary care setting.

Prospective, non-randomised, observational implementation study with a mixed-methods process evaluation conducted over 3 years (2020–2022).

Primary care practices and two regional hospitals (one tertiary, one secondary) in the Leuven region, Belgium, serving approximately 100 000 inhabitants.

100 general practitioners (GPs) from 19 practices participated. A total of 96 patients were included in the disease management programme. Inclusion criteria for patients included high-risk status for heart failure (HF) readmission, based on clinical criteria. Exclusion criteria were not explicitly defined but participation required informed consent.

Four interventions were implemented: (1) online HF education for GPs, (2) reimbursed natriuretic peptide (NP) testing, (3) patient education by trained primary care HF educators and (4) a structured transitional care protocol posthospital discharge.

Primary outcomes included GP self-efficacy in HF management, NP testing rates, HF registration in electronic health records and patient self-efficacy (9-item European Heart Failure Self-Care Behaviour Scale (EHFScB-9)). Secondary outcomes included patient quality of life (Short Form-12 questionnaire (SF-12)), hospital readmission rates and provider satisfaction.

GPs felt more competent in the management of HF after an online education (eight point increase in self-efficacy score after 6 months follow-up, (CI 2.9 to 13, p

The IMPACT-B study demonstrated that an integrated disease management programme for HF could be implemented and assessed in routine clinical practice. The programme resulted in increased awareness and registration of HF in primary care, increased self-management of patients and improved follow-up after discharge, although these results should be interpreted cautiously given the uncontrolled pre-post study design.

Trial registration NCT04334447 (clinicaltrials.gov).