Economic Evaluation of Palliative Management versus Peritoneal Dialysis and Hemodialysis for End-Stage Renal Disease- Evidence for Coverage Decisions in Thailand

Jan 1, 2007, 00:00
10.1111/j.1524-4733.2006.00145.x
https://www.valueinhealthjournal.com/article/S1098-3015(10)60455-X/fulltext
Title : Economic Evaluation of Palliative Management versus Peritoneal Dialysis and Hemodialysis for End-Stage Renal Disease- Evidence for Coverage Decisions in Thailand
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(10)60455-X&doi=10.1111/j.1524-4733.2006.00145.x
First page :
Section Title :
Open access? : No
Section Order : 7

Objectives

To examine the value for money of including peritoneal dialysis (PD) or hemodialysis (HD) into the universal health insurance scheme of Thailand.

Methods

A probabilistic Markov model applied to end-stage renal disease (ESRD) patients aged 20 to 70 years was developed to examine the incremental cost-effectiveness ratio (ICER) of palliative care versus 1) providing PD as an initial treatment followed by HD if complications/switching occur; and 2) providing HD followed by PD if complications/switching occur. Input parameters were extracted from a national cohort, the Thailand Renal Replacement Therapy Registry, and systematic reviews, where possible. The study explored the effects of uncertainty around input parameters, presented as cost-effectiveness acceptability frontier, as well as the value of obtaining further information on chosen parameters, i.e., partial expected value of perfect information.

Results

Using a societal perspective, the average ICER of initial treatment with PD and the average ICER of initial treatment with HD were 672,000 and 806,000 Baht per quality-adjusted life-year (QALY) gained (52,000 and 63,000 purchasing power parity [PPP] US$/QALY) compared with palliative care. Providing treatments for younger ESRD patients resulted in a significant improvement of survival and gain of QALYs compared with the older aged group. The cost-effectiveness and cost-utility ratios of both options for the older age group were relatively similar.

Conclusion

The results suggest that offering PD as initial treatment was a better choice than offering HD, but it would only be considered a cost-effective strategy if the social willingness-to-pay threshold was at or higher than 700,000 Baht per QALY (54,000 PPP US$/QALY) for the age 20 group and 750,000 Baht per QALY (58,000 PPP US$/QALY) for age 70 years.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Specific Diseases & Conditions
  • Study Approaches
  • Urinary/Kidney Disorders
  • Value of Information
Tags :
  • dialysis
  • economic evaluation
  • renal failure
  • Thailand
  • value of information
Regions :
  • Asia Pacific (including Oceania)
ViH Article Tags :