title: Cost-effectiveness of haemodialysis and peritoneal dialysis for patients with end-stage renal disease in Singapore.
abstract: OBJECTIVE
  This study aimed to evaluate the cost-effectiveness of haemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) for patients with end-stage renal disease (ESRD) in Singapore.
  
  
  METHODS
  A Markov model was developed to examine the incremental cost-effectiveness ratios (ICERs) of HD, CAPD and APD over the 10-year time horizon from the societal perspective, using clinical data from an observational study and the national renal registry, utilities from published studies and costs from dialysis services providers. The base-case analysis was for a hypothetical cohort of 60-year-old non-diabetic ESRD patients. A high-risk group of 60-year-old diabetic ESRD patients was also studied.
  
  
  RESULTS
  In the base-case analysis, the quality-adjusted life-years (QALYs) were 3.27 with CAPD, 3.48 with APD and 4.69 with HD. The total costs were Singapore dollar $169 872 for CAPD, $201 509 for APD and $306 827 for HD. CAPD and HD had extended dominance over APD. The ICER of HD versus CAPD was $96 447 (US$69 121) per QALY. One-way sensitivity analyses indicated that the results were most sensitive to the utility of HD. Probabilistic sensitivity analyses demonstrated that CAPD had the maximum probability of being cost-effective among treatments under evaluation at a willingness-to-pay (WTP) threshold of $60 000 (US$43 000) per QALY. The high-risk group analyses showed similar results. The ICER of HD versus CAPD was $106 281 (US$76 168) per QALY and the probability of CAPD being optimal was the highest using the same WTP threshold.
  
  
  CONCLUSIONS
  Our analysis suggested that starting dialysis with CAPD is most cost-effective for ESRD patients in Singapore.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore.
authors.forename: Fan
authors.initials: F
authors.lastname: Yang
authors.affiliation: Division of Nephrology, University Medicine Cluster, National University Health System, Singapore.
authors.forename: Titus
authors.initials: T
authors.lastname: Lau
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore.
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D064887:Observational Studies as Topic; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: automated peritoneal dialysis; continuous ambulatory peritoneal dialysis; cost-effectiveness; end-stage renal disease; haemodialysis