Cost-effectiveness analysis of hemodialysis plus hemoperfusion versus hemodialysis alone in adult patients with end-stage renal disease in China

Abstract

Background: This study evaluates the cost-effectiveness of hemodialysis (HD) plus hemoperfusion (HP) with HD alone in adult patients with end-stage renal disease (ESRD) in China.Methods: A Markov model was constructed to assess the cost-effectiveness of interventions over a lifetime horizon. Model parameters were informed by the HD/HP trial, the first randomized, open-label multicenter trial comparing survival outcomes and incidence of cardiovascular disease (CVD) for HD + HP versus HD alone, and supplemented by published literature and expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) with respect to quality adjusted life-years (QALY). The robustness of the results was examined in extensive sensitivity analyses. Analyses were conducted from a healthcare perspective. Costs were reported in both Chinese Renminbi (RMB) and US Dollars (USD) in 2019 values. Results:The base case ICER of HD + HP is RMB 174,486 (USD 25,251) per QALY, which is lower than the RMB 212,676 (USD 30,778) willingness-to-pay threshold of three times Gross Domestic Product. This conclusion is sensitive to the mortality for patients with no severe CVD events, the incidence of CVD events, and the cost of HP and HD. At a willingness-to-pay threshold of RMB 212,676 (USD 30,778) per QALY gained, the probability that HD + HP is cost-effective is 58%.

Which Patient Phenotype Is the Ideal Candidate for Hemoadsorption in Acute and Chronic Kidney Disease?

“…[19,20] In these circumstances, large clinical trials have demonstrated significant symptom reduction with improvement in quality of life in the group of patients treated with HA-HDx for at least one of the three sessions each week [21,22] and have led to the consideration that HA-HDx may represent a sustainable, cost-effective new frontier in chronic blood purification. [19][20][21][22][23] The logic and rationale behind the improvement is the high capacity of the sorbent to remove solutes in the mediumlarge molecular weight and even small protein-bound toxins responsible for the uremia retention syndrome. [7,24] We may therefore conclude that HA-HDx represents a viable option for chronic blood purification in those patients where classic dialysis techniques fail to achieve adequate correction of signs and symptoms and an acceptable quality of life.…”

Effect of different hemodialysis modalities on hepcidin clearance in patients undergoing maintenance hemodialysis

“…This is the first attempt at hepcidin clearance research by four dialysis modalities, HD, HDF, HD + HP, and HDF + HP until now. HD + HP had been proved to perform better than HD in improving the overall survival rates, cardiac function, cardiovascular events, and quality of life in MHD patients, 17 the cost‐effectiveness analysis suggested the HD/HDF + HP treatment should be cost‐effective for ESRD patients in China 18 . Our findings might not only help to further explain why the combined therapies are better than the HD/HDF alone but also supply novel therapy advice to improve anemia management in MHD patients.…”

Cost-Minimization Analysis of Medications Used in the Management of End-stage Renal Disease

“…3 Though there are many RRT are available, the choice and adherence are based on the patient's financial background and affordability. 4 The term Pharmacoeconomics (PE) defined as "the studies that evaluates the behavior of individuals, firms, and markets relevant to the use of pharmaceutical products, services, and programs, and which majorly focuses on the costs (inputs) and consequences (outcomes) of that use. 5,6 The PE evaluations includes the Cost Minimization Analysis (CMA), Cost Effectiveness Analysis (CEA), Cost Utility Analysis (CUA), and Cost Benefit Analyses (CBA).…”