Filtering for the best policy: An economic evaluation of policy options for kidney replacement coverage in the Philippines

Bayani, Diana Beatriz; Almirol, Bernadette Joy Q; Uy, Geovin Dexter C; Taneo, Mary Joy S; DANGUILAN, ROMINA; Arakama, Mel-Hatra I.; Lamban, Arlene; Leon, Donnah de; Pamugas, G.E.P.; Luz, Alia; Teerawatananon, Yot

doi:10.1111/nep.13830

Cited by 12 publications

(18 citation statements)

References 14 publications

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“…Our baseline utility for dialysis patients in Thailand was relatively low (0.68 ± 0.1) (23). This was similar to what had been reported in a study from the Philippines (16). In contrast, a study from Malaysia showed a higher baseline utility (the utility was 0.91 for patients with ESKD) (24).…”

Section: Discussionsupporting

confidence: 86%

“…In contrast, a study from Malaysia showed a higher baseline utility (the utility was 0.91 for patients with ESKD) (24). The utility of patients after KT was even greater, ranging between 0.91 and 0.99 (16,24). These results reflect the improved quality of life after KT in real-world practice.…”

Section: Discussionmentioning

confidence: 94%

“…There were 13 transitional probabilities (Tp) as dialysis to KT (Tp1), dialysis to dialysis (Tp2), dialysis to death (Tp3), KT to 1-year post-KT (Tp4), KT to dialysis (Tp5), KT to death (Tp6), 1-year post-KT to subsequent-year post-KT (Tp7), 1-year post-KT to dialysis (Tp8), 1-year post-KT to death (Tp9), subsequent-year post-KT to dialysis (Tp10), subsequent-year post-KT to subsequent-year post-KT (Tp11), subsequent-year post-KT to death (Tp12), and death to death (Tp13). This model was based on an article by Bayani et al (16), which presented the first model-based economic evaluation utilizing real-world data in the context of the Philippines. The arrows between the health states in Figure 1 represent the ability to transition between the health states in each cycle of the model.…”

Section: Description Of the Economic Model And Economic Evaluationsmentioning

confidence: 99%

“…The utility of each of the 4 health states (dialysis, KT, 1-year post-KT, and subsequent-year post-KT) was calculated based on published literature (16,23,24). We estimated the utility of all patients in the dialysis state based on the Thailand public health survey conducted by Teerawattananon et al (23).…”

Section: Utility Datamentioning

confidence: 99%

“…We estimated the utility of all patients in the dialysis state based on the Thailand public health survey conducted by Teerawattananon et al (23). We also estimated the utility of KT based on previous literature (16,24). Bavanandan et al (24) measured utilities using the EQ-5D-3L questionnaire (25) in pre-and post-KT Malaysian populations; a total of 118 adult patients were assessed.…”

Section: Utility Datamentioning

confidence: 99%

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Preemptive Living-Related Kidney Transplantation Is a Cost-Saving Strategy Compared With Post-dialysis Kidney Transplantation in Thailand

et al. 2022

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BackgroundCompared with other kidney replacement therapies, preemptive kidney transplantation (KT) provides better clinical outcomes, reduces mortality, and improves the quality of life of patients with end-stage kidney disease (ESKD). However, evidence related to the cost-effectiveness of preemptive living-related KT (LRKT) is limited, especially in low- and middle-income countries, such as Thailand. This study compared the cost-effectiveness of LRKT with those of non-preemptive KT strategies.MethodsCost and clinical data were obtained from adult patients who underwent KT at Siriraj Hospital, Mahidol University, Thailand. A decision tree and Markov model were used to evaluate and compare the lifetime costs and health-related outcomes of LRKT with those of 2 KT strategies: non-preemptive LRKT and non-preemptive deceased donor KT (DDKT). The model’s input parameters were sourced from the hospital’s database and a systematic review. The primary outcome was incremental cost-effectiveness ratios (ICERs). Costs are reported in 2020 United States dollars (USD). One-way and probabilistic sensitivity analyses were performed.ResultsOf 140 enrolled KT patients, 40 were preemptive LRKT recipients, 50 were non-preemptive LRKT recipients, and the rest were DDKT recipients. There were no significant differences in the baseline demographic data, complications, or rejection rates of the three groups of patients. The average costs per life year gained were $10,647 (preemptive LRKT), $11,708 (non-preemptive LRKT), and $11,486 (DDKT). The QALY gained of the preemptive option was 0.47 compared with the non-preemptive strategies. Preemptive LRKT was the best-buy strategy. The sensitivity analyses indicated that the model was robust. Within all varied ranges of parameters, preemptive LRKT remained cost-saving. The probability of preemptive LRKT being cost-saving was 79.4%. Compared with non-preemptive DDKT, non-preemptive LRKT was not cost-effective at the current Thai willingness-to-pay threshold of $5113/QALY gained.ConclusionsPreemptive LRKT is a cost-saving strategy compared with non-preemptive KT strategies. Our findings should be considered during evidence-based policy development to promote preemptive LRKT among adults with ESKD in Thailand.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 94%

Section: Description Of the Economic Model And Economic Evaluationsmentioning

confidence: 99%

Section: Utility Datamentioning

confidence: 99%

Section: Utility Datamentioning

confidence: 99%

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Preemptive Living-Related Kidney Transplantation Is a Cost-Saving Strategy Compared With Post-dialysis Kidney Transplantation in Thailand

et al. 2022

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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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Gaps and challenges in the provision of treatment for patients with end-stage renal disease: perspectives from the Philippines

Pajimna,

Orpilla,

Milan

et al. 2023

The Lancet Regional Health - Western Pacific

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Filtering for the best policy: An economic evaluation of policy options for kidney replacement coverage in the Philippines

Cited by 12 publications

References 14 publications

Preemptive Living-Related Kidney Transplantation Is a Cost-Saving Strategy Compared With Post-dialysis Kidney Transplantation in Thailand

Preemptive Living-Related Kidney Transplantation Is a Cost-Saving Strategy Compared With Post-dialysis Kidney Transplantation in Thailand

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

Gaps and challenges in the provision of treatment for patients with end-stage renal disease: perspectives from the Philippines

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