A COST-UTILITY ANALYSIS OF INITIATING PATIENTS ON PERITONEAL DIALYSIS VERSUS IN-CENTRE HAEMODIALYSIS IN THE UNITED KINGDOM
Author(s)
Araadhna Sinha, MSc1, Claudia Rinciog, MSc1, Tara Li, MSc, PhD1, James Fotheringham, PhD2, Mark Lambie, PhD3, Jennifer Allen, PhD4, Reginald Lassagne, MSc5, Meagen Hicks, MSc5, Susan Berek, MA, MSc6, Patrick Jolomba, MSc5, Vanessa Danielson, MSc5.
1Symmetron, London, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom, 3School of Medicine, Keele University, Staffordshire, United Kingdom, 4Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, 5Vantive, Liverpool, United Kingdom, 6Vantive ULC, Mississauga, ON, Canada.
1Symmetron, London, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom, 3School of Medicine, Keele University, Staffordshire, United Kingdom, 4Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, 5Vantive, Liverpool, United Kingdom, 6Vantive ULC, Mississauga, ON, Canada.
OBJECTIVES: To conduct a transparent, de novo analysis to estimate the cost-utility of initiating peritoneal dialysis (PD) versus in-centre haemodialysis (ICHD) in adults with kidney failure in the United Kingdom (UK), using contemporary registry and cost data.
METHODS: A Markov state-transition model compared PD and ICHD as initial dialysis modalities over a lifetime horizon, using a UK National Health Service perspective. Patients could transition between dialysis modalities, transplantation, post-transplantation states, and death. Transition probabilities were informed by UK Renal Registry data, reflecting real-world switching patterns. Modality-specific survival was extrapolated from European registry data using parametric survival functions. Costs were taken from a UK micro-costing study and utilities were taken from published UK sources. The structure, inputs and assumptions were validated by UK clinical experts. Outcomes included life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness. Robustness was assessed through one-way and probabilistic sensitivity analyses, and scenarios testing alternative inputs and assumptions.
RESULTS: Initiation on PD dominated initiation on ICHD, generating 0.15 additional QALYs and £19,728 lower lifetime costs per patient. It was associated with higher life-years, reflecting early survival benefits. Less time was spent in more costly HD health states, generating cost savings. In one-way sensitivity analysis, PD remained dominant when influential parameters were varied individually. In probabilistic sensitivity analyses, PD initiation had a 100% probability of being cost-effective at a willingness-to-pay threshold of £30,000/QALY. It remained dominant when testing alternative parameter inputs in scenario analyses. Importantly, PD remained dominant under conservative scenarios that included additional assisted PD costs and assumed equal survival between modalities.
CONCLUSIONS: Initiation of eligible patients on PD is expected to improve health outcomes while reducing lifetime NHS costs compared with ICHD. The result’s dominance across sensitivity and scenario analyses supports its robustness and strengthens the economic case for greater PD initiation in UK practice, supported by real-world data.
METHODS: A Markov state-transition model compared PD and ICHD as initial dialysis modalities over a lifetime horizon, using a UK National Health Service perspective. Patients could transition between dialysis modalities, transplantation, post-transplantation states, and death. Transition probabilities were informed by UK Renal Registry data, reflecting real-world switching patterns. Modality-specific survival was extrapolated from European registry data using parametric survival functions. Costs were taken from a UK micro-costing study and utilities were taken from published UK sources. The structure, inputs and assumptions were validated by UK clinical experts. Outcomes included life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness. Robustness was assessed through one-way and probabilistic sensitivity analyses, and scenarios testing alternative inputs and assumptions.
RESULTS: Initiation on PD dominated initiation on ICHD, generating 0.15 additional QALYs and £19,728 lower lifetime costs per patient. It was associated with higher life-years, reflecting early survival benefits. Less time was spent in more costly HD health states, generating cost savings. In one-way sensitivity analysis, PD remained dominant when influential parameters were varied individually. In probabilistic sensitivity analyses, PD initiation had a 100% probability of being cost-effective at a willingness-to-pay threshold of £30,000/QALY. It remained dominant when testing alternative parameter inputs in scenario analyses. Importantly, PD remained dominant under conservative scenarios that included additional assisted PD costs and assumed equal survival between modalities.
CONCLUSIONS: Initiation of eligible patients on PD is expected to improve health outcomes while reducing lifetime NHS costs compared with ICHD. The result’s dominance across sensitivity and scenario analyses supports its robustness and strengthens the economic case for greater PD initiation in UK practice, supported by real-world data.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE131
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Urinary/Kidney Disorders