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

Abstract

ObjectivesIn 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.MethodsA 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.ResultsLYs 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.ConclusionsThese findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.

Effect of dialysis modality on the survival of end-stage renal disease patients starting dialysis in Sabah from 2007 to 2017: a retrospective cohort study

“…However, it could also be due to the absence of a true difference between both modalities [5,19]. Given that PD as an initial dialysis modality was found to be more cost-effective than HD [20], the finding from this study, if confirmed, further strengthens the argument for the increased use of PD in the local setting. Unsurprisingly, it was found that older age and the presence of DM were significantly associated with poorer survival.…”

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia

“…For example, in Thailand, the universal coverage system followed a PD-first policy, which has resulted in a steady increase in PD uptake over time. 20 In addition to cost savings, promoting PD use could also improve access to dialysis in rural areas in countries where the funding models favor urban settings for HD centers, as described in Malaysia 21 and Indonesia. 22 Compared with the dominant public funding system for CKD care globally, government funding was responsible for nondialysis CKD care in only a third of OSEA countries and for KRT in 60% of countries.…”

A review on the Cost-Utility Analysis for the FELDA Residents in Malaysia with “Health Care Scheme (Skim Peduli Kesihatan) for the B40 Group” (PeKa B40) Coverage

“…In the result, they found that the second eye cataract surgery resulted in USD2,727 per QALY gained compared to unilateral pseudophakia [46]. A study by Surendra et al [47] in Malaysia compared the CUA for 2 types of interventions: hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) for end-stage renal disease (ESRD) patients. The authors reported that the difference was RM46595 per QALY gain for HD and RM41,527 for CAPD.…”