DEVELOPMENT OF A DECISION MODEL FOR EVALUATING THE COST-EFFECTIVENESS OF HOME HEMODIALYSIS IN JAPAN
Author(s)
Takuya Fujimaru, MD, PhD1, Shota Saito, PhD2, Hellen BABU, MPH3, Masahiko Nagahama, MD1, Yugo Ito, MD, PhD1, Fumika Taki, MD, PhD1, Michiko Suzuki, MD, PhD1, Sachiko Ohde, PhD, EdM3.
1Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan, 2Faculty of International Economic Studies, University of Niigata Prefecture, Niigata, Japan, 3Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
1Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan, 2Faculty of International Economic Studies, University of Niigata Prefecture, Niigata, Japan, 3Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
OBJECTIVES: Home hemodialysis (HHD) has been associated with improved survival, reduced cardiovascular complications, and better quality of life compared with in-center hemodialysis (ICHD). Despite its potential benefits, HHD remains underutilized in Japan, accounting for less than 1% among dialysis patients. Barriers to wider adoption include the absence of reimbursement for patient training and dialysis supply transportation costs. Although economic evaluations of HHD have been reported internationally, no decision-analytic model has been developed for the Japanese healthcare system. Therefore, we developed a decision-analytic model for HHD in Japan.
METHODS: A decision model was developed from the Japanese healthcare payer perspective through iterative discussions among nephrologists and health economists, supported by literature review and national dialysis registry data. Candidate model structures and clinical events were evaluated based on their clinical relevance and contribution to mortality among Japanese dialysis patients.
RESULTS: The final conceptual model consisted of three health states (HHD, ICHD, and death) and four major clinical events: cardiovascular disease, infection, vascular access complications, and cancer. Condition of cancer was incorporated into the conceptual model because it is a major cause of mortality among Japanese dialysis patients despite having been rarely included in previous economic evaluations of HHD. Mortality was calibrated using Japanese life tables and dialysis-specific mortality risks. Event-specific costs and utility decrements were incorporated into the model framework. Additional mortality associated with major clinical events was also included. Patients were assumed to remain on their initial dialysis modality throughout the simulation.
CONCLUSIONS: We developed a decision-analytic framework for evaluating the cost-effectiveness of HHD in Japan. The model provides a foundation for future economic evaluations and may help inform decisions regarding HHD adoption in Japan. The model may also facilitate future scenario analyses examining the impact of training reimbursement and dialysis supply transportation costs on the adoption of HHD in Japan.
METHODS: A decision model was developed from the Japanese healthcare payer perspective through iterative discussions among nephrologists and health economists, supported by literature review and national dialysis registry data. Candidate model structures and clinical events were evaluated based on their clinical relevance and contribution to mortality among Japanese dialysis patients.
RESULTS: The final conceptual model consisted of three health states (HHD, ICHD, and death) and four major clinical events: cardiovascular disease, infection, vascular access complications, and cancer. Condition of cancer was incorporated into the conceptual model because it is a major cause of mortality among Japanese dialysis patients despite having been rarely included in previous economic evaluations of HHD. Mortality was calibrated using Japanese life tables and dialysis-specific mortality risks. Event-specific costs and utility decrements were incorporated into the model framework. Additional mortality associated with major clinical events was also included. Patients were assumed to remain on their initial dialysis modality throughout the simulation.
CONCLUSIONS: We developed a decision-analytic framework for evaluating the cost-effectiveness of HHD in Japan. The model provides a foundation for future economic evaluations and may help inform decisions regarding HHD adoption in Japan. The model may also facilitate future scenario analyses examining the impact of training reimbursement and dialysis supply transportation costs on the adoption of HHD in Japan.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE281
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Urinary/Kidney Disorders