AUTOMATED PERITONEAL DIALYSIS (APD) VS HEMODIALYSIS (HD) IN CHINA: COST-UTILITY ANALYSIS
Author(s)
Xin Hu, Master‘s Candidate1, Baoying Tan, MSc2, Powei Wu, MSc2, Lin Lv, Ph.D1, Jianwei Xuan, Ph.D2.
1Southern Medical University, Guangzhou, China, 2Institute of Pharmaceutical Economics, School of Pharmacy, Sun Yat-sen University, Guangzhou, China.
1Southern Medical University, Guangzhou, China, 2Institute of Pharmaceutical Economics, School of Pharmacy, Sun Yat-sen University, Guangzhou, China.
Presentation Documents
OBJECTIVES: To assess the cost-effectiveness of automated peritoneal dialysis (APD) versus hemodialysis (HD) for adult end-stage kidney disease (ESKD) patients in China from societal, health system, and payer perspectives, and to examine a scenario analysis of APD with remote patient monitoring (RPM-APD) versus HD.
METHODS: A five-state Markov model (APD, CAPD, HD, transplant, death) with 1-year cycles over a 30-year horizon (starting age 50) and 5% discounting estimated costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay threshold was three times China’s 2024 per-capita GDP (287,247 CNY/QALY). Clinical transitions and complications were informed by recent studies; costs by Chinese literature and pricing; utilities by systematic reviews. Robustness was assessed using one-way and probabilistic sensitivity analyses.Conducted a scenario analysis assessing the cost-effectiveness of APD with remote patient monitoring (RPM) compared with HD.
RESULTS: APD dominated HD across all perspectives (lower costs, higher QALYs). Societal: incremental cost −251,477 CNY; QALYs +0.84; ICER −297,626.92 CNY/QALY; cost-effectiveness probability 100%. Health system: incremental cost −67,377.50 CNY; QALYs +0.85; ICER −79,506.57 CNY/QALY; probability 96%. Payer: incremental cost −106,635.25 CNY; QALYs +0.84; ICER −126,204.35 CNY/QALY; probability 97%. In scenario analysis, RPM-APD versus HD remained highly favorable. Societal: incremental cost −51,208.28 CNY; QALYs +1.93; ICER −26,547.77 CNY/QALY; probability 100%. Health system: ICER 46,910.46 CNY/QALY (below threshold); probability 99%. Payer: ICER −4,745.15 CNY/QALY; probability 100%.
CONCLUSIONS: For adult ESKD patients in China, APD versus HD is a dominant strategy—reducing costs while improving health outcomes—with conclusions robust across perspectives and sensitivity analyses. RPM-APD further increases QALYs while maintaining favorable economic performance.
METHODS: A five-state Markov model (APD, CAPD, HD, transplant, death) with 1-year cycles over a 30-year horizon (starting age 50) and 5% discounting estimated costs, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay threshold was three times China’s 2024 per-capita GDP (287,247 CNY/QALY). Clinical transitions and complications were informed by recent studies; costs by Chinese literature and pricing; utilities by systematic reviews. Robustness was assessed using one-way and probabilistic sensitivity analyses.Conducted a scenario analysis assessing the cost-effectiveness of APD with remote patient monitoring (RPM) compared with HD.
RESULTS: APD dominated HD across all perspectives (lower costs, higher QALYs). Societal: incremental cost −251,477 CNY; QALYs +0.84; ICER −297,626.92 CNY/QALY; cost-effectiveness probability 100%. Health system: incremental cost −67,377.50 CNY; QALYs +0.85; ICER −79,506.57 CNY/QALY; probability 96%. Payer: incremental cost −106,635.25 CNY; QALYs +0.84; ICER −126,204.35 CNY/QALY; probability 97%. In scenario analysis, RPM-APD versus HD remained highly favorable. Societal: incremental cost −51,208.28 CNY; QALYs +1.93; ICER −26,547.77 CNY/QALY; probability 100%. Health system: ICER 46,910.46 CNY/QALY (below threshold); probability 99%. Payer: ICER −4,745.15 CNY/QALY; probability 100%.
CONCLUSIONS: For adult ESKD patients in China, APD versus HD is a dominant strategy—reducing costs while improving health outcomes—with conclusions robust across perspectives and sensitivity analyses. RPM-APD further increases QALYs while maintaining favorable economic performance.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE192
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Urinary/Kidney Disorders