Economic burden and healthcare costs of congenital anomalies of the kidney and urinary tract: a systematic review
DOI:
https://doi.org/10.13181/mji.oa.258074Keywords:
cost effectiveness, economic burden, health care costs, health expenditures, urogenital abnormalitiesAbstract
BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) cause significant morbidity and economic burden worldwide, highlighting the needs to understand its associated costs. This study aimed to assess the economic burden of CAKUT management.
METHODS A systematic review was conducted across 5 databases, including PubMed, ScienceDirect, ProQuest, Nature, and Google Scholar, for studies published up to September 11, 2024, focusing on both direct (e.g., hospitalizations, surgeries, and treatments) and indirect (e.g., lost work time and complications management) healthcare costs related to CAKUT and published in English. Non-economic studies, reviews, editorials, abstracts, animal/in vitro studies, and duplicates were excluded. Methodological quality was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions tool. Narrative synthesis and descriptive statistics were applied. Cost-effectiveness analysis followed Joanna Briggs Institute guidelines.
RESULTS 8 studies met the inclusion criteria, revealing wide variations in CAKUT-related healthcare costs across countries and interventions. These studies focused on reviewing both direct and indirect costs, along with interventions that reduce overall healthcare expenditure. Key findings include: (1) In the USA, bilateral renal agenesis costs averaged USD 26,032; (2) In Australia, early whole exome sequencing reduced diagnostic costs by 20% in genetic kidney disease cases; (3) Robotic surgery demonstrated long-term cost-effectiveness despite higher inpatient costs; (4) Other cost-saving strategies include the early renal ultrasound algorithm and genomic testing for CAKUT.
CONCLUSIONS CAKUT imposes a significant and variable economic burden globally. Identifying cost-effective interventions is crucial for optimizing care and reducing the financial impact. Further research on cost management strategies is needed to improve outcomes and efficiency.
Downloads
References
Mahmoud AH, Talaat IM, Tlili A, Hamoudi R. Congenital anomalies of the kidney and urinary tract. Front Med (Lausanne). 2024;11:1384676. https://doi.org/10.3389/fmed.2024.1384676
Harada R, Hamasaki Y, Okuda Y, Hamada R, Ishikura K. Epidemiology of pediatric chronic kidney disease/kidney failure: learning from registries and cohort studies. Pediatr Nephrol. 2022;37(6):1215-29. https://doi.org/10.1007/s00467-021-05145-1
Dolk H, Loane M, Garne E. The prevalence of congenital anomalies in Europe. Adv Exp Med Biol. 2010;686:349-64. https://doi.org/10.1007/978-90-481-9485-8_20
Cornwell LB, Ingulli EG, Mason MD, Ewing E, Riddell JV. Renal transplants due to congenital anomalies of the kidney and urinary tract (CAKUT) have better graft survival than non-CAKUT controls: analysis of over 10,000 patients. Urology. 2021;154:255-62. https://doi.org/10.1016/j.urology.2021.01.005
Monteverde ML, Paz M, Ibáñez JP, Chaparro AB, Solernou V, Sager C, et al. Kidney transplantation in children with CAKUT and non-CAKUT causes of chronic kidney disease: do they have the same outcomes? Pediatr Transplant. 2020;24(8):e13763. https://doi.org/10.1111/petr.13763
Forster CS, Wood AC, Davis-Rodriguez S, Chang PW, Desai S, Tchou M, et al. Frequency of treatment failure of UTIs in children with congenital urinary tract anomalies. Hosp Pediatr. 2024;14(3):189-96. https://doi.org/10.1542/hpeds.2023-007427
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
Turner HC, Lauer JA, Tran BX, Teerawattananon Y, Jit M. Adjusting for inflation and currency changes within health economic studies. Value Health. 2019;22(9):1026-32. https://doi.org/10.1016/j.jval.2019.03.021
Shemilt I, Mugford M, Drummond M, Eisenstein E, Mallender J, McDaid D, et al. Economics methods in Cochrane systematic reviews of health promotion and public health related interventions. BMC Med Res Methodol. 2006;6:55. https://doi.org/10.1186/1471-2288-6-55
Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. 2nd edition. Chichester: John Wiley & Sons; 2019. https://doi.org/10.1002/9781119536604
The Joanna Briggs Institute. The Joanna Briggs Institute reviewers' manual 2014: the systematic review of economic evaluation evidence. Adelaide: The Joanna Briggs Institute; 2014.
Becherucci F, Landini S, Palazzo V, Cirillo L, Raglianti V, Lugli G, et al. A clinical workflow for cost-saving high-rate diagnosis of genetic kidney diseases. J Am Soc Nephrol. 2023;34(4):706-20. https://doi.org/10.1681/ASN.0000000000000076
Fernández N, Congote JV, Varela D, Prada JG, Zarante I, Seba JE, et al. Creation of a pilot surgical program for the comprehensive management of patients with congenital urological malformations. Urol Colomb. 2022;31(3):96-101. https://doi.org/10.1055/s-0042-1744465
Huang J, Huang Z, Mei H, Rong L, Zhou Y, Guo J, et al. Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. Surg Endosc. 2023;37(11):8404-20. https://doi.org/10.1007/s00464-023-10399-x
Guarino S, Di Sessa A, Riccio S, Capalbo D, Reginelli A, Cappabianca S, et al. Early renal ultrasound in patients with congenital solitary kidney can guide follow-up strategy reducing costs while keeping long-term prognostic information. J Clin Med. 2022;11(4):1052. https://doi.org/10.3390/jcm11041052
Nguyen JE, Salemi JL, Tanner JP, Kirby RS, Sutsko RP, Ashmeade TL, et al. Survival and healthcare utilization of infants diagnosed with lethal congenital malformations. J Perinatol. 2018;38(12):1674-84. https://doi.org/10.1038/s41372-018-0227-3
Wu Y, Jayasinghe K, Stark Z, Quinlan C, Patel C, McCarthy H, et al. Genomic testing for suspected monogenic kidney disease in children and adults: a health economic evaluation. Genet Med. 2023;25(11):100942. https://doi.org/10.1016/j.gim.2023.100942
Sowa PM, Mallett AJ, Connelly LB. Genetic kidney disease has a higher likelihood and cost of inpatient admissions compared to other aetiologies. Genet Med Open. 2024;2:101876. https://doi.org/10.1016/j.gimo.2024.101876
Shaikh N, Rajakumar V, Peterson CG, Gorski J, Ivanova A, Gravens Muller L, et al. Cost-utility of antimicrobial prophylaxis for treatment of children with vesicoureteral reflux. Front Pediatr. 2020;7:530. https://doi.org/10.3389/fped.2019.00530
Davis E, Young D, Waters E, Gold L. Children and adolescents, measuring the quality of life of. International Encyclopedia of Public Health (second edition). Elsevier; 2017. p. 539-45. https://doi.org/10.1016/B978-0-12-803678-5.00066-7
Murugapoopathy V, Gupta IR. A primer on congenital anomalies of the kidneys and urinary tracts (CAKUT). Clin J Am Soc Nephrol. 2020;15(5):723-31. https://doi.org/10.2215/CJN.12581019
Zhao B, Ivanova A, Shaikh N. Antimicrobial prophylaxis for vesicoureteral reflux: which subgroups of children benefit the most? Pediatr Nephrol. 2024;39(6):1859-63. https://doi.org/10.1007/s00467-024-06291-y
Baktiar MP, Wardhana MP, Prasetyo RV, Renaldo J, Ernawati E. Problem in diagnosis and management of congenital anomalies kidney and urinary tract (cakut) in developing countries: a case series. J Med Pharm Chem Res. 2024;6(4):474-80. https://doi.org/10.48309/jmpcr.2024.427676.1043
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Akbar Muzakki Alvarino, Reza Pahlevi, Gerhard Renaldi Situmorang, Irfan Wahyudi, Arry Rodjani, Putu Angga Risky Raharja
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
