Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score

Abstract

Although treatment for the dialysis population is resource intensive, a cost-effectiveness analysis comparing hemodialysis (HD) and peritoneal dialysis (PD) by matched pairs is still lacking. After matching for clinical characteristics and propensity scores, we identified 4,285 pairs of incident HD and PD patients from a Taiwanese national cohort during 1998–2010. Survival and healthcare expenditure were calculated by data of 14-year follow-up and subsequently extrapolated to lifetime estimates under the assumption of constant excess hazard. We performed a cross-sectional EQ–5D survey on 179 matched pairs of prevalent HD and PD patients of varying dialysis vintages from 12 dialysis units. The product of survival probability and the mean utility value at each time point (dialysis vintage) were summed up throughout lifetime to obtain the quality-adjusted life expectancy (QALE). The results revealed the estimated life expectancy between HD and PD were nearly equal (19.11 versus 19.08 years). The QALE’s were also similar, whereas average lifetime healthcare costs were higher in HD than PD (237,795 versus 204,442 USD) and the cost-effectiveness ratios for PD and HD were 13,681 and 16,643 USD per quality-adjusted life year, respectively. In conclusion, PD is more cost-effective than HD, of which the major determinants were the costs for the dialysis modality and its associated complications.

Lifetime cost-effectiveness analysis of first-line dialysis modalities for patients with end-stage renal disease under peritoneal dialysis first policy

“…Our priori hypothesis that PD was more cost-effective than hospital-based HD from healthcare provider's viewpoint was supported by our current finding. Such principal finding was in line with priority setting of other developed countries such as UK [12], Sweden [28], Singapore [29] and Taiwan [30], and thus supported the implementation of "Peritoneal Dialysis First" policy. When making pairwise comparisons between PD and home-based HD, the incremental cost-effectiveness ratio was USD$12,020 and USD$10,357 per one additional QALY gained from healthcare provider's and societal viewpoints, respectively.…”

Conflict when making decisions about dialysis modality

“…Although HD continues to be the most common mode of dialysis, there is not enough evidence to support choosing one type of dialysis over the other. Both HD and PD showed similar outcomes in mortality and morbidity (Chang et al, 2016;Kumar, Sidell, Jones, & Vonesh, 2014;Sinnakirouchenan & Holley, 2011). The majority of ESRD patients are medically fit for either HD or PD.…”

Health-Related Quality of Life and Its Factors of Hemodialysis Patients in Suzhou, China

“…As a result, health-related quality of life (HRQOL), which is a multi-dimensional health outcomes measure, was required to holistically evaluate the impact of HD on patients’ functioning and well-being. Besides its comprehensive evaluation of patients’ health, HRQOL values are useful data to assess disease burden, health-care quality, and cost-effectiveness analysis [6-9]. …”