Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis.

Naren Kumar Surendra,Abdul Halim Abdul Gafor,Ong Loke Meng,Fariz Safhan Mohamad Nor,Shahnaz Shah Firdaus Khan,Lai Seong Hooi,Mohd Rizal Abdul Manaf,Sunita Bavanandan,Wisit Cheungpasitporn

doi:10.1371/journal.pone.0218422

Abstract

ObjectivesIn Malaysia, there is exponential growth of patients on dialysis. Dialysis treatment consumes a considerable portion of healthcare expenditure. Comparative assessment of their cost effectiveness can assist in providing a rational basis for preference of dialysis modalities.MethodsA cost utility study of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was conducted from a Ministry of Health (MOH) perspective. A Markov model was also developed to investigate the cost effectiveness of increasing uptake of incident CAPD to 55% and 60% versus current practice of 40% CAPD in a five-year temporal horizon. A scenario with 30% CAPD was also measured. The costs and utilities were sourced from published data which were collected as part of this study. The transitional probabilities and survival estimates were obtained from the Malaysia Dialysis and Transplant Registry (MDTR). The outcome measures were cost per life year (LY), cost per quality adjusted LY (QALY) and incremental cost effectiveness ratio (ICER) for the Markov model. Sensitivity analyses were performed.ResultsLYs saved for HD was 4.15 years and 3.70 years for CAPD. QALYs saved for HD was 3.544 years and 3.348 for CAPD. Cost per LY saved was RM39,791 for HD and RM37,576 for CAPD. The cost per QALY gained was RM46,595 for HD and RM41,527 for CAPD. The Markov model showed commencement of CAPD in 50% of ESRD patients as initial dialysis modality was very cost-effective versus current practice of 40% within MOH. Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs.ConclusionsThese findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.

Highlights

Life years (LY) saved for HD was 4.15 years and 3.70 years for CAPD
Quality adjusted life year (QALY) saved for HD was 3.544 years and 3.348 for CAPD
Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs. These findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective

Summary

Introduction

Renal replacement therapy (RRT) is the usual choice of treatment for patients suffering from end stage renal disease (ESRD), which includes dialysis, either hemodialysis (HD) or peritoneal dialysis (PD) and a kidney transplant. A kidney transplant is the best choice of treatment in patients suffering from ESRD, the waiting list for transplantation continue to grow despite kidney transplants from live donors due to the organ scarcity [1]. Dialysis modality selection in various countries is influenced by non-medical factors including financial and reimbursement policy [2,3,4]. Both HD and PD are costly, specific advantages and disadvantages have been identified for each of them. Economic evaluations of dialysis modalities in Malaysia are still lacking despite the continuous growth of ESRD patients at an alarming rate. Peritoneal dialysis is underutilized it is considered a more cost-effective, if not, cost-effective treatment as compared to HD around the world [1, 7,8,9]

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