title: Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score.
abstract: Although treatment for the dialysis population is resource intensive, a cost-effectiveness analysis comparing hemodialysis (HD) and peritoneal dialysis (PD) by matched pairs is still lacking. After matching for clinical characteristics and propensity scores, we identified 4,285 pairs of incident HD and PD patients from a Taiwanese national cohort during 1998-2010. Survival and healthcare expenditure were calculated by data of 14-year follow-up and subsequently extrapolated to lifetime estimates under the assumption of constant excess hazard. We performed a cross-sectional EQ-5D survey on 179 matched pairs of prevalent HD and PD patients of varying dialysis vintages from 12 dialysis units. The product of survival probability and the mean utility value at each time point (dialysis vintage) were summed up throughout lifetime to obtain the quality-adjusted life expectancy (QALE). The results revealed the estimated life expectancy between HD and PD were nearly equal (19.11 versus 19.08 years). The QALE's were also similar, whereas average lifetime healthcare costs were higher in HD than PD (237,795 versus 204,442 USD) and the cost-effectiveness ratios for PD and HD were 13,681 and 16,643 USD per quality-adjusted life year, respectively. In conclusion, PD is more cost-effective than HD, of which the major determinants were the costs for the dialysis modality and its associated complications.
authors.affiliation: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors.forename: Jing-Shiang
authors.initials: JS
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, and School of Medicine for International Students, I-Shou University, Kaohsiung.
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan.
authors.forename: Min-Sung
authors.initials: MS
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jia-Ling
authors.initials: JL
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics* / Q000401:mortality; D057216:Propensity Score; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics* / Q000401:mortality; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology