Economic Analysis of a Ketoanalogue-Supplemented Very Low-Protein Diet in Patients with Chronic Kidney Disease in Taiwan and Thailand

Published:September 27, 2022DOI:
      This paper is only available as a PDF. To read, Please Download here.



      A vegetarian very low-protein diet supplemented with ketoanalogues of essential amino acids (sVLPD) delays dialysis initiation in patients with chronic kidney disease (CKD). In this cost-effectiveness analysis, we compare an sVLPD with a conventional low-protein diet (LPD) in patients with CKD stage 4–5 using data from Taiwan and Thailand.

      Design and Methods

      A Markov model simulated health outcomes and care costs in patients receiving an sVLPD (0.3–0.4 g/kg-day, vegetarian diet) supplemented with ketoanalogues (1 tablet/5 kg-day) or an LPD (0.6 g/kg-day, mixed proteins). Health state transition probability and resource cost inputs were based on published literature and local sources, respectively.


      An sVLPD increased survival and quality-adjusted life years (QALYs) at a lower cost than an LPD. Total cost of care in Taiwan was 2,262,592.30 NTD (68,059.35 EUR) with an LPD and 1,096,938.20 NTD (32,996.18 EUR) with an sVLPD (difference, –1,165,654.10 NTD; –35,063.17 EUR). Total cost of care in Thailand was 500,731.09 THB (14,584.12 EUR) with an LPD and 421,019.22 THB (12,262.46 EUR) with an sVLPD (difference, –79,711.86 THB; –2,321.66 EUR).


      A ketoanalogue-supplemented vegetarian sVLPD increased QALYs and lowered lifetime care costs versus an LPD in patients with pre-dialysis CKD in Taiwan and Thailand. These data, together with the new KDOQI Guidelines for nutrition in CKD, support dietary intervention using ketoanalogue-supplemented vegetarian sVLPDs to prevent CKD progression and postpone dialysis as a cost-effective approach, with beneficial effects for patients and healthcare providers.