Lifetime cost-effectiveness analysis of first-line dialysis modalities for patients with end-stage renal disease under peritoneal dialysis first policy

Carlos K H Wong,Cindy L K Lam,Samuel K S Fung,Irene Kong,T M Chan,Maggie Mok,Julie Chen,Yuk Lun Cheng,Sing Leung Lui,Wai Kei Lo

doi:10.1186/s12882-020-1708-0

Abstract

BackgroundThis study aimed to determine the lifetime cost-effectiveness of first-line dialysis modalities for end-stage renal disease (ESRD) patients under the “Peritoneal Dialysis First” policy.MethodsLifetime cost-effectiveness analyses from both healthcare provider and societal perspectives were performed using Markov modelling by simulating at age 60. Empirical data on costs and health utility scores collected from our studies were combined with published data on health state transitions and survival data to estimate the lifetime cost, quality-adjusted life-years (QALYs) and cost-effectiveness of three competing dialysis modalities: peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD.ResultsFor cost-effectiveness analysis over a lifetime horizon from the perspective of healthcare provider, hospital-based HD group (lifetime cost USD$142,389; 6.58 QALYs) was dominated by the PD group (USD$76,915; 7.13 QALYs). Home-based HD had the highest effectiveness (8.37 QALYs) but with higher cost (USD$97,917) than the PD group. The incremental cost-effectiveness ratio (ICER) was USD$16,934 per QALY gained for home-based HD over PD. From the societal perspective, the results were similar and the ICER was USD$1195 per QALY gained for home-based HD over PD. Both ICERs fell within the acceptable thresholds. Changes in model parameters via sensitivity analyses had a minimal impact on ICER values.ConclusionsThis study assessed the cost-effectiveness of dialysis modalities and service delivery models for ESRD patients under “Peritoneal Dialysis First” policy. For both healthcare provider and societal perspectives, PD as first-line dialysis modality was cost-saving relative to hospital-based HD, supporting the existing PD First or favoured policy. When compared with PD, Nocturnal home Home-based HD was considered a cost-effective first-line dialysis modality for ESRD patients.

Highlights

This study aimed to determine the lifetime cost-effectiveness of first-line dialysis modalities for endstage renal disease (ESRD) patients under the “Peritoneal Dialysis First” policy
From the healthcare provider perspective, hospital-based HD group had higher cost USD$142,389 than peritoneal dialysis (PD) but the lowest effectiveness 6.58 Quality-adjusted life-year (QALY), and so it was dominated by the PD group
The incremental cost-effectiveness ratio (ICER) of USD$16,934 per QALY gained for home-based HD over PD

Summary

Introduction

This study aimed to determine the lifetime cost-effectiveness of first-line dialysis modalities for endstage renal disease (ESRD) patients under the “Peritoneal Dialysis First” policy. PD is offered as the first-line dialysis treatment to incident dialysis patients in public healthcare sector, whereas HD is offered to patients who have medical contraindications for PD Another alternative available in Hong Kong is the nocturnal home HD program launched in 2006 [7, 8], commencing HD treatment at home. This option is the least popular, consistent with data from United States Renal Data System, in which only 2.7% of prevalent dialysis patients received home HD [9]

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Conclusion