A DIALYSIS-REVEALED WILLINGNESS-TO-PAY THRESHOLD FOR END-STAGE RENAL DISEASE: COST-UTILITY OF TRANSPLANTATION VERSUS DIALYSIS IN MOROCCO
Author(s)
Omar Maoujoud, MD, PhD1, Amal Yassine, MD, PhD1, Intissar Haddiya, MD, PhD2.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
OBJECTIVES: To estimate whether kidney transplantation is cost-effective versus dialysis for the Moroccan statutory payer, and the health cost of under-transplantation, using a threshold based on what the payer pays for dialysis, not a borrowed benchmark.
METHODS: A lifetime cohort state-transition model compared a first kidney transplant with continued dialysis (statutory payer perspective, 40-year horizon, 3% discounting). Mortality combined a transplant-versus-dialysis hazard ratio and a dialysis standardised mortality ratio with general-population mortality (World Population Prospects 2024, Morocco). Utilities followed a published meta-analysis; costs came from national tariffs and the official drug-price database. Avoided dialysis was derived endogenously as the between-arm difference in lifetime dialysis time, including post-failure returns, not a fixed annuity. Dialysis was costed at the facility tariff (132,600/year) and an all-inclusive cost (200,000/year). Cost-effectiveness used a dialysis-revealed threshold (210,476 MAD/QALY) and an opportunity-cost threshold (17,500 MAD/QALY). Uncertainty used 10,000 simulations and one-way sensitivity analysis (CHEERS 2022).
RESULTS: Each transplant gained 3.93 QALYs at an ICER of 27,562 MAD/QALY. Transplantation was cost-effective in all simulations against the dialysis-revealed threshold, in 45% against the opportunity-cost threshold, and dominant in 27%. Net payer impact ranged from a 108,281 MAD cost at the facility tariff to a 189,853 MAD saving at the all-inclusive cost. Closing the gap would recover about 44,500 QALYs over 20 years (range 23,000-75,000), with a budget effect between a 1.2 billion MAD cost and a 2.2 billion saving.
CONCLUSIONS: At the cost the payer actually carries per dialysis-year, transplantation dominates it. The verdict holds against the dialysis-revealed threshold but not a strict opportunity-cost threshold, so it depends on accepting a sovereign threshold for end-stage renal disease. Persistent under-transplantation is a supply decision, not payer economics; its price is a large population QALY loss. The living-donor pathway shows the gap can be closed with capacity already financed for dialysis.
METHODS: A lifetime cohort state-transition model compared a first kidney transplant with continued dialysis (statutory payer perspective, 40-year horizon, 3% discounting). Mortality combined a transplant-versus-dialysis hazard ratio and a dialysis standardised mortality ratio with general-population mortality (World Population Prospects 2024, Morocco). Utilities followed a published meta-analysis; costs came from national tariffs and the official drug-price database. Avoided dialysis was derived endogenously as the between-arm difference in lifetime dialysis time, including post-failure returns, not a fixed annuity. Dialysis was costed at the facility tariff (132,600/year) and an all-inclusive cost (200,000/year). Cost-effectiveness used a dialysis-revealed threshold (210,476 MAD/QALY) and an opportunity-cost threshold (17,500 MAD/QALY). Uncertainty used 10,000 simulations and one-way sensitivity analysis (CHEERS 2022).
RESULTS: Each transplant gained 3.93 QALYs at an ICER of 27,562 MAD/QALY. Transplantation was cost-effective in all simulations against the dialysis-revealed threshold, in 45% against the opportunity-cost threshold, and dominant in 27%. Net payer impact ranged from a 108,281 MAD cost at the facility tariff to a 189,853 MAD saving at the all-inclusive cost. Closing the gap would recover about 44,500 QALYs over 20 years (range 23,000-75,000), with a budget effect between a 1.2 billion MAD cost and a 2.2 billion saving.
CONCLUSIONS: At the cost the payer actually carries per dialysis-year, transplantation dominates it. The verdict holds against the dialysis-revealed threshold but not a strict opportunity-cost threshold, so it depends on accepting a sovereign threshold for end-stage renal disease. Persistent under-transplantation is a supply decision, not payer economics; its price is a large population QALY loss. The living-donor pathway shows the gap can be closed with capacity already financed for dialysis.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR140
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), Urinary/Kidney Disorders