OBJECTIVES:

HD (Hemodialysis) is the dominant modality among ESRD patients in Korea, so the role of dialyzer is quite important for treatment outcomes. Theranova® (dialyzer of expanded hemodialysis, HDx) is a medium cut-off dialyzer that allows for better clearance of large middle molecules than traditional high-flux dialyzers. Compared to high flux HD, HDx via Theranova® has been associated with reduced treatments for anemia and lower risk of all-cause and cardiovascular hospitalization. This budget impact analysis evaluates healthcare costs aligned with clinical factor between Theranova® and conventional hemodialysis (HD) with a high-flux dialyzer in Korea.

METHODS:

A budget impact model has been developed that compares the incremental costs of a 5-year (assuming 5.8% in baseline year and 6.5% in 5-year period) maintenance HD period in scenarios where Theranova® is adopted and Theranova® is not adopted. We compared the direct medical cost of dialyzers, hospitalization, and mandatory required medications (Iron, ESA use). For healthcare resource consumptions, dialyzer usage pattern, length of stay and frequency of medications were captured. The model included clinical effect parameters from randomized controlled trial of Theranova® versus high flux in the US. KSN (the Korean Society of Nephrology) 2019 registry data, HIRA (Health Insurance Review Assessment) agency data and consultation with physicians were taken as key references. Applied discount rate was 4.5% and sensitivity analyses were conducted.

RESULTS:

The budget impact analysis showed that a gradual adoption of Theranova® led to incremental cost of 60,085,283,951 KRW (around 48,068,227 USD) savings over 5-years of time horizon. Lower costs were attributed reduced cost of hospitalization by 58,795,897,510 KRW(around 47,036,718 USD). Costs of ESA and iron were also reduced by 878,448,507 KRW (around 702,759 USD) and 410, 937, 934 KRW(around 328,750 USD), respectively.

CONCLUSIONS:

Theranova® leads to reduction of hospitalization and medications. Its increased adoption provides economic benefit by reduction of healthcare cost.