Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in IndonesiaReport as inadecuate




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Objectives

This study aims to assess the value for money and budget impact of offering hemodialysis HD as a first-line treatment, or the HD-first policy, and the peritoneal dialysis PD first policy compared to a supportive care option in patients with end-stage renal disease ESRD in Indonesia.

Methods

A Markov model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years LYs and quality-adjusted life years QALYs. Three policy options were compared, i.e., the PD-first policy, HD-first policy, and supportive care.

Results

The PD-first policy for ESRD patients resulted in 5.93 life years, equal to the HD-first policy, with a slightly higher QALY gained 4.40 vs 4.34. The total lifetime cost for a patient under the PD-first policy is around 700 million IDR, which is lower than the cost under the HD-first policy, i.e. 735 million IDR per patient. Compared to supportive care, the incremental cost-effectiveness ratio of the PD-first policy is 193 million IDR per QALY, while the HD-first policy resulted in 207 million IDR per QALY. Budget impact analysis indicated that the required budget for the PD-first policy is 43 trillion IDR for 53% coverage and 75 trillion IDR for 100% coverage in five years, which is less than the HD-first policy, i.e. 88 trillion IDR and 166 trillion IDR.

Conclusions

The PD-first policy was found to be more cost-effective compared to the HD-first policy. Budget impact analysis provided evidence on the enormous financial burden for the country if the current practice, where HD dominates PD, continues for the next five years.



Author: Afiatin, Levina Chandra Khoe , Erna Kristin, Lusiana Siti Masytoh, Eva Herlinawaty, Pitsaphun Werayingyong, Mardiati Nadjib, Sudi

Source: http://plos.srce.hr/



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