BOOSTING HOME DIALYSIS UPTAKE BY SETTING FIXED MODALITY CEILINGS- IS IT AN EVIDENCE-BASED POLICY APPROACH?
Author(s)
Grimm J1, Busink E2, Kendzia D2, Apel C2, Evers S1
1Maastricht University, Maastricht, The Netherlands, 2Fresenius Medical Care, Bad Homburg vor der Höhe, Germany
OBJECTIVES: There is a global payer tendency to foster the share of home dialysis modalities (HDM) for cost saving purposes, with some countries, e.g. the Netherlands, proposing to set fixed modality ceilings. The aim was to analyse whether this is an evidence-based policy approach considering cost-effectiveness as well as patient preferences and healthcare professionals (HCP) perspectives towards HDM. METHODS: In order to assess current evidence, two systematic literature reviews (SR) were conducted to identify economic evaluations of home vs. ambulatory or hospital dialysis (SR 1) and to explore patient preferences and HCP perspectives (SR 2). To match global with local evidence, we additionally performed qualitative in-depth semi-structured interviews with Dutch dialysis patients and HCP. RESULTS: Of 1056 initial identified studies, twelve economic evaluations (SR 1) were included. The majority of studies reported positive effects on quality-adjusted life years and cost savings associated with HDM. The consecutive patient and HCP HDM preference analysis (SR 2) identified 22 studies revealing (1) patient characteristics and demographics, (2) family situation, (3) patient motivation, and (4) dialysis reimbursement to influence HDM uptake. Interviews generally supported these findings and stressed financial disincentives for providers as a main barrier for increasing patient access to HDM. CONCLUSIONS: Available economic evaluations fail to reflect the complex nature and course of End-Stage Renal Disease. Today’s cost assessments are carried out “situative” and do not incorporate all relevant cost categories. Modality preferences depend on a large variety of factors and thus differ substantially among patients and HCP. Therefore, we conclude that the current evidence only allows limited informed decision-making for policymakers on setting fixed dialysis modality ceilings. Future studies need to crucially consider the patient journey, incorporating the medical/social necessity of modality switch and patient preferences. Further, all associated costs need to be analysed, including informal caregiver burden
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PMD122
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes
Disease
Urinary/Kidney Disorders