Economic evaluation of peritoneal dialysis and hemodialysis in Thai population with End-stage Kidney Disease
Montira Assanatham, อรลักษณ์ พัฒนาประทีป*, Anan Chuasuwan, เกรียงศักดิ์ วารีแสงทิพย์, อุปถัมภ์ ศุภสินธุ์, อดิสรณ์ ลำเพาพงศ์, Paweena Susantitaphong, Chutatip Limkunakul, Wanchana Ponthongmak, Kamolpat Chaiyakittisopon, อัมรินทร์ ืทักขิญเสถียร, Atiporn Ingsathit
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road., Ratchathewi, Bangkok, Thailand; Oraluck.pat@mahidol.ac.th; chuasuwan.md@gmail.com
บทคัดย่อ
Background: This study aimed to conduct a cost-utility analysis of the “Peritoneal Dialysis (PD)-First” policy in 2008 under a universal health coverage scheme and hemodialysis (HD) in Thai patients with End-stage Kidney Disease (ESKD) using updated real-practice data.
Methods: Markov model was used to evaluate the cost-utility of two modalities, stratified into five age groups based on the first modality taken at 20, 30, 40, 50, and 60 years old from government and societal perspectives. Input parameters related to clinical aspects and cost were obtained from 15 hospitals throughout Thailand and Thai Renal Replacement Therapy databases. Both costs and outcomes were discounted at 3%, adjusted to 2021, and converted
to USD (1 USD = 33.57 Thai Baht). One-way analysis and probabilistic sensitivity analysis were performed to assess the uncertainty surrounding model parameters.
Results: From the government perspective, compared to PD-first policy, the incremental cost-effectiveness ratio (ICER) was between 19,434 and 23,796 USD per QALY. Conversely, from a societal perspective, the ICER was between 31,913 and 39,912 USD per QALY. Both are higher than the willingness to pay threshold of 4,766 USD per QALY.
Conclusion: By applying the updated real-practice data, PD-first policy still remains more cost-effective than HD-first policy at the current willingness to pay. However, HD gained more quality-adjusted life years than PD. This information will assist clinicians and policymakers in determining the future direction of dialysis modality selection and kidney
replacement therapy reimbursement policies for ESKD patients.
 
ที่มา
BMC Health Services Research ปี 2565, November ปีที่: 22 ฉบับที่ 1 หน้า 1-10
คำสำคัญ
Hemodialysis, Economic evaluation, Peritoneal dialysis, End-stage kidney disease