DERIVING A LOCAL COST-EFFECTIVENESS THRESHOLD FROM DIALYSIS EXPENDITURE: IMPLICATIONS FOR RARE KIDNEY DISEASE REIMBURSEMENT
Author(s)
Omar Maoujoud, PhD, MD1, 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: Morocco lacks an official cost-effectiveness threshold; analyses use weakly justified World Health Organization benchmarks (one to three times gross domestic product [GDP] per capita). Yet the payer reimburses dialysis for nearly all kidney-failure patients, its largest chronic-disease cost, revealing an implied willingness to pay per quality-adjusted life-year (QALY). We estimated this threshold, its uncertainty, and its effect on rare-disease reimbursement.
METHODS: The implied threshold was the incremental cost-effectiveness ratio of dialysis versus best supportive care, payer perspective. Because both arms are stable chronic states, the discount annuity cancels: the ratio equals annual dialysis cost divided by dialysis utility, independent of horizon and rate. Cost used national tariffs (public-private weighted to all-inclusive); utility from a meta-analysis. Uncertainty used one-way and probabilistic analysis (10,000 iterations). It was compared with an opportunity-cost threshold and imported benchmarks, each applied to a worked example (primary hyperoxaluria type 1) for affordable price and displaced health.
RESULTS: The implied threshold was 191,900 to 241,900 dirhams per QALY (5.5 to 6.9 times GDP; probabilistic mean 193,000, 95% CI 144,000 to 252,000). From the opportunity-cost threshold to this level, affordable price rose only 18% (47,900 to 56,700 dirhams/year), catalogue price staying over 98% higher; the verdict was insensitive to model and benchmark, the dialysis offset dominating value. The cost fell on displaced health: at the revealed threshold, 11 to 14 QALYs are forgone elsewhere per QALY gained.
CONCLUSIONS: Dialysis expenditure yields a local, auditable benchmark replacing imported thresholds. As a lower bound it exposes an allocative inconsistency: renal survival is funded near six times GDP, the budget displacing health near half of GDP. Three options follow: align rare-disease decisions with this value, optimise dialysis reimbursement, or set an explicit national threshold. Verdicts are benchmark-independent for offset-dominated therapies; benchmark choice matters only when health gains dominate.
METHODS: The implied threshold was the incremental cost-effectiveness ratio of dialysis versus best supportive care, payer perspective. Because both arms are stable chronic states, the discount annuity cancels: the ratio equals annual dialysis cost divided by dialysis utility, independent of horizon and rate. Cost used national tariffs (public-private weighted to all-inclusive); utility from a meta-analysis. Uncertainty used one-way and probabilistic analysis (10,000 iterations). It was compared with an opportunity-cost threshold and imported benchmarks, each applied to a worked example (primary hyperoxaluria type 1) for affordable price and displaced health.
RESULTS: The implied threshold was 191,900 to 241,900 dirhams per QALY (5.5 to 6.9 times GDP; probabilistic mean 193,000, 95% CI 144,000 to 252,000). From the opportunity-cost threshold to this level, affordable price rose only 18% (47,900 to 56,700 dirhams/year), catalogue price staying over 98% higher; the verdict was insensitive to model and benchmark, the dialysis offset dominating value. The cost fell on displaced health: at the revealed threshold, 11 to 14 QALYs are forgone elsewhere per QALY gained.
CONCLUSIONS: Dialysis expenditure yields a local, auditable benchmark replacing imported thresholds. As a lower bound it exposes an allocative inconsistency: renal survival is funded near six times GDP, the budget displacing health near half of GDP. Three options follow: align rare-disease decisions with this value, optimise dialysis reimbursement, or set an explicit national threshold. Verdicts are benchmark-independent for offset-dominated therapies; benchmark choice matters only when health gains dominate.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR191
Topic
Economic Evaluation, Health Policy & Regulatory, Methodological & Statistical Research
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
Pediatrics, Rare & Orphan Diseases, Urinary/Kidney Disorders