DEVELOPING A COST-UTILITY MODEL IN A SOUTH KOREAN CHRONIC HEMODIALYSIS SETTING: THE CASE FOR IMPLEMENTATION OF HIGH-VOLUME HEMODIAFILTRATION
Author(s)
Jovana Petrovic, MPH1, Do-Yeon Lim, MSc2, Aleksandra Kozlova, MSc1, Ellen Busink, BSc, MSc3.
1Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany, 2Fresenius Medical Care Korea, Seoul, Korea, Republic of, 3Senior Director in Market Access Health Economics, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
1Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany, 2Fresenius Medical Care Korea, Seoul, Korea, Republic of, 3Senior Director in Market Access Health Economics, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
OBJECTIVES: High-volume hemodiafiltration (HVHDF) is a dialysis modality defined by convection volumes ≥23L/session. Compared to high-flux hemodialysis (HD), it is associated with improved survival and quality of life. Despite these benefits, HDF uptake in South Korea remains low, with only 11.9% of patients receiving HDF in 2024. The use of HVHDF, which requires greater resource intensity, is likely to be even more limited, due to the lack of premium reimbursement. This study aims to evaluate the cost-effectiveness of HVHDF compared to HD in the South Korean healthcare setting.
METHODS: A deterministic cost-utility model was created based on the model of the CONVINCE trial using Korean data. The Markov model structure and key assumptions followed the CONVINCE model. Two scenarios were assessed: (1) baseline Korean healthcare system perspective and (2) excluding costs in additional life years gained. Included costs comprised of dialysis intervention, hospitalization and ESA costs based on Korean data. HVHDF effects on hospitalization were informed by Zhang et al. 2026, ESA effects by NICE 2018, and utility and mortality effects by the CONVINCE trial.
RESULTS: In scenario (1) HVHDF was associated with 0.94 QALY gains versus HD, with total per-patient costs of 412,118,396.37KRW versus 397,623,754.23KRW, respectively. The ICER was 15,482,643.33KRW/QALY gained. In scenario (2) the ICER was (-1,445,679.94KRW/QALY) indicating HVHDF may be a cost-saving therapy when additional life year costs are excluded. Hospitalization savings were the main driver of cost offsets. Conversely, additional costs were mainly incurred during additional life years gained and not by HVHDF intervention costs.
CONCLUSIONS: HVHDF remained cost-effective at the South Korean willingness-to-pay threshold of 30milion KRW. Exclusion of costs incurred by additional life years gained resulted in HVHDF becoming cost saving, due to reduction in overall healthcare cost driven by decreased hospitalization and medication. Further evaluation of premium reimbursement may support increased HVHDF uptake in South Korea.
METHODS: A deterministic cost-utility model was created based on the model of the CONVINCE trial using Korean data. The Markov model structure and key assumptions followed the CONVINCE model. Two scenarios were assessed: (1) baseline Korean healthcare system perspective and (2) excluding costs in additional life years gained. Included costs comprised of dialysis intervention, hospitalization and ESA costs based on Korean data. HVHDF effects on hospitalization were informed by Zhang et al. 2026, ESA effects by NICE 2018, and utility and mortality effects by the CONVINCE trial.
RESULTS: In scenario (1) HVHDF was associated with 0.94 QALY gains versus HD, with total per-patient costs of 412,118,396.37KRW versus 397,623,754.23KRW, respectively. The ICER was 15,482,643.33KRW/QALY gained. In scenario (2) the ICER was (-1,445,679.94KRW/QALY) indicating HVHDF may be a cost-saving therapy when additional life year costs are excluded. Hospitalization savings were the main driver of cost offsets. Conversely, additional costs were mainly incurred during additional life years gained and not by HVHDF intervention costs.
CONCLUSIONS: HVHDF remained cost-effective at the South Korean willingness-to-pay threshold of 30milion KRW. Exclusion of costs incurred by additional life years gained resulted in HVHDF becoming cost saving, due to reduction in overall healthcare cost driven by decreased hospitalization and medication. Further evaluation of premium reimbursement may support increased HVHDF uptake in South Korea.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE30
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Thresholds & Opportunity Cost
Disease
SDC: Urinary/Kidney Disorders