Economic evaluation of End Stage Renal Disease treatments in Iran

Abstract

Background: End-stage Renal Disease is considered a health problem due to the high prevalence and economic burden on society and the health system. This study utilizes a cost-utility analysis to evaluate the costs and outcomes of the Iranian End Stage Renal Disease patients. Methods: A Markov model-based economic evaluation with a societal perspective, and a lifetime horizon performed to quantify the costs and health-related outcomes in terms of QALY. Direct medical costs obtained from hospital billing and medical records and direct non-medical costs, and indirect costs derived from interviews with patients. Three policy options, the hemodialysis, peritoneal dialysis and kidney transplantation were compared. Most of the Transplants from deceased and rest were from Live Related Donors. One-way and probabilistic sensitivity analyses were performed to study uncertainty. Results: Annual average cost of hemodialysis is $13477 cost of peritoneal dialysis is $12865, and cost of Transplantation is $16450.The Transplantation arm gained 9.43 QALY compared with peritoneal dialysis and hemodialysis with 6.95 and 6.04 QALY respectively. When Transplantation was compared with peritoneal dialysis, Incremental Cost-Effectiveness Ratio was $1744 per QALY. ICER value suggests that Transplantation is cost-effective compared with peritoneal dialysis at a willingness-to-pay threshold of $12,400, and hemodialysis was dominated. Conclusion: This study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.

The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations

“…The included studies were from upper-middle-income countries and high-income countries. The study population of all studies were patients with ESKD, but only four studies described characteristics of the base case population [20,24,27,29]. Five of the ten studies conducted a CUA [20][21][22][23][24], one conducted a CEA [25], and four conducted both a CEA and CUA [26][27][28][29].…”

“…The study population of all studies were patients with ESKD, but only four studies described characteristics of the base case population [20,24,27,29]. Five of the ten studies conducted a CUA [20][21][22][23][24], one conducted a CEA [25], and four conducted both a CEA and CUA [26][27][28][29]. Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively.…”

“…Five of the ten studies conducted a CUA [20][21][22][23][24], one conducted a CEA [25], and four conducted both a CEA and CUA [26][27][28][29]. Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively. Four studies were conducted from a public healthcare perspective [21,22,24,27], three from a societal perspective [20,23,29] and three from a third-party payer perspective [25,26,28].…”

“…Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively. Four studies were conducted from a public healthcare perspective [21,22,24,27], three from a societal perspective [20,23,29] and three from a third-party payer perspective [25,26,28]. Figure 2 shows the proportions of included studies that complied with applicable items of the CHEERS checklist.…”

“…The majority of model-based economic evaluations used a four-state Markov model approach and the remaining studies developed the Markov model with eight, 12, and 38 states. Moradpour et al [20] and Villa et al [23] used the same four-state model structure, but the model by Moradpour et al [20] applied the 1-month cycle length and the model by Villa et al [23] applied the 1-year cycle length. Haller et al [27] defined 12 different states depending on time of initiation of a certain treatment modality.…”