Economic evaluation of palliative management versus peritoneal dialysis and hemodialysis for end-stage renal disease: evidence for coverage decisions in Thailand.
OBJECTIVE
To examine the value for money of including peritoneal dialysis (PD) or hemodialysis (HD) into the universal health insurance scheme of Thailand.


METHODS
A probabilistic Markov model applied to end-stage renal disease (ESRD) patients aged 20 to 70 years was developed to examine the incremental cost-effectiveness ratio (ICER) of palliative care versus 1) providing PD as an initial treatment followed by HD if complications/switching occur; and 2) providing HD followed by PD if complications/switching occur. Input parameters were extracted from a national cohort, the Thailand Renal Replacement Therapy Registry, and systematic reviews, where possible. The study explored the effects of uncertainty around input parameters, presented as cost-effectiveness acceptability frontier, as well as the value of obtaining further information on chosen parameters, i.e., partial expected value of perfect information.


RESULTS
Using a societal perspective, the average ICER of initial treatment with PD and the average ICER of initial treatment with HD were 672,000 and 806,000 Baht per quality-adjusted life-year (QALY) gained (52,000 and 63,000 purchasing power parity [PPP] US$/QALY) compared with palliative care. Providing treatments for younger ESRD patients resulted in a significant improvement of survival and gain of QALYs compared with the older aged group. The cost-effectiveness and cost-utility ratios of both options for the older age group were relatively similar.


CONCLUSIONS
The results suggest that offering PD as initial treatment was a better choice than offering HD, but it would only be considered a cost-effective strategy if the social willingness-to-pay threshold was at or higher than 700,000 Baht per QALY (54,000 PPP US$/QALY) for the age 20 group and 750,000 Baht per QALY (58,000 PPP US$/QALY) for age 70 years.
Teerawattananon
Yot
Y
Ministry of Public Health, Nonthaburi, Thailand. yot@ihpp.thaigov.net
Mugford
Miranda
M
Tangcharoensathien
Viroj
V
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics; D010166:Palliative Care / Q000191:economics*; D010530:Peritoneal Dialysis / Q000191:economics*; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics*; D016019:Survival Analysis; D013785:Thailand; D019472:Universal Health Insurance