Cost-effectiveness analysis of renal replacement therapy strategies in Guangzhou city, southern China

Yang, Fei; Liao, Meixia; Wang, Pusheng; Liu, Yongguang

doi:10.1136/bmjopen-2020-039653

Cited by 12 publications

(6 citation statements)

References 36 publications

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“…The vast majority of studies (13/19) considered an incident population (i.e. patients who were starting dialysis for the first time) [ 29 – 41 ], while 6/19 studies did not specify, or considered a prevalent or mixed incident/prevalent population [ 42 – 47 ]. One study presented outcomes for subgroups of patients with or without diabetes [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…One study presented outcomes for subgroups of patients with or without diabetes [ 30 ]. In total, ten studies compared the cost-effectiveness of ICHD with PD only (or also with transplant, which is not a treatment option of consideration for this analysis) [ 30 , 31 , 33 , 34 , 37 , 39 , 40 , 42 , 45 , 47 ], while a further three studies compared HD with PD only, but the location of HD (in centre or at home) was not reported [ 38 , 41 , 44 ]. Three studies compared ICHD with HHD only [ 32 , 36 , 43 ], two studies compared ICHD with HHD and PD [ 29 , 35 ], while one study considered HD administered in-centre, at a satellite centre, as self-care or at home compared with PD [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Utility values applied ranged from 0.54 to 0.85 for ICHD, 0.54 to 0.75 for HHD, and 0.54 to 0.905 for PD (Table 2 ). Five studies applied a constant utility value across each dialysis modality [ 35 , 38 , 40 , 41 , 46 ]. Only one study applied a disutility for complications that led to treatment switching [ 31 ], and one study applied disutilities for the occurrence of certain adverse events [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

et al. 2022

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Objectives Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. Methods A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). Results In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. Conclusions Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

et al. 2022

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“…In a study conducted in China [ 28 ], three different scenarios were compared to the current situation (HD 73%; PD 14%; kidney transplant 13%). The second scenario was HD 47%; PD 40%; transplant 13%.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective?

Yousefi,

Rezaei,

Hajebrahimi

et al. 2024

BMC Nephrol

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Background There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. Methods From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. Findings : Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. Conclusion Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.

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“…The transition probability of active disease to ESRD or from remission to ESRD was derived from observational studies with long-term follow-up [ 7 , 20 – 24 ]. The transition probability of ESRD to dialysis or to kidney transplant and probability of dialysis or kidney transplant to death were collected from the cohort studies in China [ 25 , 26 ]. We assumed that the transition probability of active disease to death is equal to that of remission to death, and the data was from the chronic kidney disease mortality published in the official website of China National Bureau of Statistics [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Immunosuppressive therapy for progressive idiopathic membranous nephropathy: a cost-effectiveness analysis in China

Zhang

et al. 2023

BMC Health Serv Res

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Background This study aims to evaluate the cost-effectiveness of immunosuppressive therapy for patients with progressive idiopathic membranous nephropathy (IMN) from the Chinese healthcare system perspective. Methods To estimate the cost-effectiveness of four regimens namely cyclophosphamide, cyclosporine, rituximab and tacrolimus-rituximab in treatment of IMN recommended by the updated Kidney Disease: Improving Global Outcomes (KDIGO) guideline 2021, a Markov model with five discrete states (active disease, remission, dialysis, kidney transplant and death) based on IMN patients aged 50 or above over a 30-years time horizon was constructed. Total costs were imputed from the Chinese healthcare system perspective, and health outcomes were converted into quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was used to describe the results. The willingness-to-pay (WTP) threshold was set at $12,044 (China’s 2021 Gross Domestic Product per capita). Sensitivity analyses were performed to test the uncertainties of the results. Result Compared with cyclophosphamide, both cyclosporine (incremental cost $28,337.09, incremental QALY-1.63) and tacrolimus-rituximab (incremental cost $28,324.13, incremental QALY -0.46) were considered at strictly dominated for their negative values in QALYs, and the ICER value of rituximab was positive (incremental cost $9,162.19, incremental QALY 0.44). Since the ICER of rituximab exceeds the pre-determined threshold, cyclophosphamide was likely to be the best choice for the treatment of IMN within the acceptable threshold range. The results of the sensitivity analysis revealed that the model outcome was mostly affected by the probability of remission in rituximab. In a probabilistic sensitivity analysis, cyclophosphamide had 62.4% probability of being cost-effective compared with other regimens when the WTP was $12,044 per QALY. When WTP exceeded $18,300, rituximab was more cost-effective than cyclophosphamide. Conclusion Compared with cyclosporine, rituximab and tacrolimus-rituximab, our model results indicated that cyclophosphamide represented the most cost-effective regimen for patients with progressive IMN in China.

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Cost-effectiveness analysis of renal replacement therapy strategies in Guangzhou city, southern China

Cited by 12 publications

References 36 publications

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective?

Immunosuppressive therapy for progressive idiopathic membranous nephropathy: a cost-effectiveness analysis in China

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