Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia.
BACKGROUND
This is a multi-centre study to determine cost efficiency and cost effectiveness of the Ministry of Health centre haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) programme.


METHODS
Forty-four haemodialysis and 11 CAPD centres were enrolled in this study in 2001. Sixty patients, 30 from each modality, were evaluated. Micro-costing was used to determine costs.


RESULTS
The number of haemodialyses conducted ranged from 402 to 23,000 procedures per year, while for CAPD, output ranged from 70 to 2300 patient months/year. Cost ranged from RM79.61 to RM475.79 per haemodialysis treatment, with a mean cost of RM169 per HD (USD 1 = RM 3.80). The cost of CAPD treatment ranged from RM1400 to RM3200 per patient month, with a mean of RM2186. Both modalities incurred similar outpatient costs. The cost of erythropoeitin per year is RM4500 and RM2500 for haemodialysis and CAPD, respectively. The number of life years saved is 10.96 years for haemodialysis and 5.21 years for CAPD. Cost per life year saved is RM33 642 for haemodialysis and RM31 635 for CAPD. The cost for land, building, equipment, overheads, and staff were higher for haemodialysis, while consumables and hospitalization cost more for CAPD. Sensitivity analysis was performed for two discount rates (3 and 5%), varying erythropoietin doses and maximum and minimum overheads. Relative cost effectiveness of haemodialysis and CAPD was unchanged in all sensitivity scenarios, except for overhead costs, which influenced the cost effectiveness of HD.


CONCLUSIONS
It is economically viable to promote the use of both CAPD and haemodialysis because the cost effectiveness of both are nearly equal.
Hooi
Lai Seong
LS
Haemodialysis Unit, Sultanah Aminah Hospital, Johor Bahru 80100, Malaysia. laihooi@pd.jaring.my
Lim
Teck Onn
TO
Goh
Adrian
A
Wong
Hin Seng
HS
Tan
Chwee Choon
CC
Ahmad
Ghazali
G
Morad
Zaki
Z
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006436:Hemodialysis Units, Hospital / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics*; D006435:Renal Dialysis / Q000191:economics*