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Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis

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  • Naren Kumar Surendra
  • Mohd Rizal Abdul Manaf
  • Lai Seong Hooi
  • Sunita Bavanandan
  • Fariz Safhan Mohamad Nor
  • Shahnaz Shah Firdaus Khan
  • Ong Loke Meng
  • Abdul Halim Abdul Gafor

Abstract

Objectives: In Malaysia, there is exponential growth of patients on dialysis. Dialysis treatment consumes a considerable portion of healthcare expenditure. Comparative assessment of their cost effectiveness can assist in providing a rational basis for preference of dialysis modalities. Methods: A cost utility study of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was conducted from a Ministry of Health (MOH) perspective. A Markov model was also developed to investigate the cost effectiveness of increasing uptake of incident CAPD to 55% and 60% versus current practice of 40% CAPD in a five-year temporal horizon. A scenario with 30% CAPD was also measured. The costs and utilities were sourced from published data which were collected as part of this study. The transitional probabilities and survival estimates were obtained from the Malaysia Dialysis and Transplant Registry (MDTR). The outcome measures were cost per life year (LY), cost per quality adjusted LY (QALY) and incremental cost effectiveness ratio (ICER) for the Markov model. Sensitivity analyses were performed. Results: LYs saved for HD was 4.15 years and 3.70 years for CAPD. QALYs saved for HD was 3.544 years and 3.348 for CAPD. Cost per LY saved was RM39,791 for HD and RM37,576 for CAPD. The cost per QALY gained was RM46,595 for HD and RM41,527 for CAPD. The Markov model showed commencement of CAPD in 50% of ESRD patients as initial dialysis modality was very cost-effective versus current practice of 40% within MOH. Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs. Conclusions: These findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.

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  • Naren Kumar Surendra & Mohd Rizal Abdul Manaf & Lai Seong Hooi & Sunita Bavanandan & Fariz Safhan Mohamad Nor & Shahnaz Shah Firdaus Khan & Ong Loke Meng & Abdul Halim Abdul Gafor, 2019. "Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0218422
    DOI: 10.1371/journal.pone.0218422
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    References listed on IDEAS

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    1. Catrin Treharne & Frank Liu & Murat Arici & Lydia Crowe & Usman Farooqui, 2014. "Peritoneal Dialysis and In-Centre Haemodialysis: A Cost-Utility Analysis from a UK Payer Perspective," Applied Health Economics and Health Policy, Springer, vol. 12(4), pages 409-420, August.
    2. Andrew H. Briggs & A. E. Ades & Martin J. Price, 2003. "Probabilistic Sensitivity Analysis for Decision Trees with Multiple Branches: Use of the Dirichlet Distribution in a Bayesian Framework," Medical Decision Making, , vol. 23(4), pages 341-350, July.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    4. Afiatin & Levina Chandra Khoe & Erna Kristin & Lusiana Siti Masytoh & Eva Herlinawaty & Pitsaphun Werayingyong & Mardiati Nadjib & Sudigdo Sastroasmoro & Yot Teerawattananon, 2017. "Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-10, May.
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    1. Ellen Busink & Dana Kendzia & Fatih Kircelli & Sophie Boeger & Jovana Petrovic & Helen Smethurst & Stephen Mitchell & Christian Apel, 2023. "A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(3), pages 377-392, April.

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