Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis

Naren Kumar Surendra, Mohd Rizal Abdul Manaf, Lai Seong Hooi, Sunita Bavanandan, Fariz Safhan Mohamad Nor, Shahnaz Shah Firdaus Khan, Ong Loke Meng, Abdul Halim Abdul Gafor

Research output: Contribution to journalArticle

Abstract

Objectives In Malaysia, there is exponential growth of patients on dialysis. Dialysis treatment consumes a considerable portion of healthcare expenditure. Comparative assessment of their cost effectiveness can assist in providing a rational basis for preference of dialysis modalities. Methods A cost utility study of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was conducted from a Ministry of Health (MOH) perspective. A Markov model was also developed to investigate the cost effectiveness of increasing uptake of incident CAPD to 55% and 60% versus current practice of 40% CAPD in a five-year temporal horizon. A scenario with 30% CAPD was also measured. The costs and utilities were sourced from published data which were collected as part of this study. The transitional probabilities and survival estimates were obtained from the Malaysia Dialysis and Transplant Registry (MDTR). The outcome measures were cost per life year (LY), cost per quality adjusted LY (QALY) and incremental cost effectiveness ratio (ICER) for the Markov model. Sensitivity analyses were performed. Results LYs saved for HD was 4.15 years and 3.70 years for CAPD. QALYs saved for HD was 3.544 years and 3.348 for CAPD. Cost per LY saved was RM39,791 for HD and RM37,576 for CAPD. The cost per QALY gained was RM46,595 for HD and RM41,527 for CAPD. The Markov model showed commencement of CAPD in 50% of ESRD patients as initial dialysis modality was very cost-effective versus current practice of 40% within MOH. Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs. Conclusions These findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.

Original languageEnglish
Article numbere0218422
JournalPLoS ONE
Volume14
Issue number10
DOIs
Publication statusPublished - 1 Jan 2019

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hemodialysis
Dialysis
Continuous Ambulatory Peritoneal Dialysis
Malaysia
dialysis
kidney diseases
Chronic Kidney Failure
Cost-Benefit Analysis
Renal Dialysis
Health
Costs and Cost Analysis
Costs
Quality-Adjusted Life Years
Therapeutics
cost effectiveness
Cost effectiveness
Health Expenditures
quality-adjusted life year
Registries
Transplants

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia : Hemodialysis versus continuous ambulatory peritoneal dialysis. / Surendra, Naren Kumar; Manaf, Mohd Rizal Abdul; Hooi, Lai Seong; Bavanandan, Sunita; Nor, Fariz Safhan Mohamad; Khan, Shahnaz Shah Firdaus; Meng, Ong Loke; Gafor, Abdul Halim Abdul.

In: PLoS ONE, Vol. 14, No. 10, e0218422, 01.01.2019.

Research output: Contribution to journalArticle

Surendra, Naren Kumar ; Manaf, Mohd Rizal Abdul ; Hooi, Lai Seong ; Bavanandan, Sunita ; Nor, Fariz Safhan Mohamad ; Khan, Shahnaz Shah Firdaus ; Meng, Ong Loke ; Gafor, Abdul Halim Abdul. / Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia : Hemodialysis versus continuous ambulatory peritoneal dialysis. In: PLoS ONE. 2019 ; Vol. 14, No. 10.
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abstract = "Objectives In Malaysia, there is exponential growth of patients on dialysis. Dialysis treatment consumes a considerable portion of healthcare expenditure. Comparative assessment of their cost effectiveness can assist in providing a rational basis for preference of dialysis modalities. Methods A cost utility study of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) was conducted from a Ministry of Health (MOH) perspective. A Markov model was also developed to investigate the cost effectiveness of increasing uptake of incident CAPD to 55{\%} and 60{\%} versus current practice of 40{\%} CAPD in a five-year temporal horizon. A scenario with 30{\%} CAPD was also measured. The costs and utilities were sourced from published data which were collected as part of this study. The transitional probabilities and survival estimates were obtained from the Malaysia Dialysis and Transplant Registry (MDTR). The outcome measures were cost per life year (LY), cost per quality adjusted LY (QALY) and incremental cost effectiveness ratio (ICER) for the Markov model. Sensitivity analyses were performed. Results LYs saved for HD was 4.15 years and 3.70 years for CAPD. QALYs saved for HD was 3.544 years and 3.348 for CAPD. Cost per LY saved was RM39,791 for HD and RM37,576 for CAPD. The cost per QALY gained was RM46,595 for HD and RM41,527 for CAPD. The Markov model showed commencement of CAPD in 50{\%} of ESRD patients as initial dialysis modality was very cost-effective versus current practice of 40{\%} within MOH. Reduction in CAPD use was associated with higher costs and a small devaluation in QALYs. Conclusions These findings suggest provision of both modalities is fiscally feasible; increasing CAPD as initial dialysis modality would be more cost-effective.",
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AU - Bavanandan, Sunita

AU - Nor, Fariz Safhan Mohamad

AU - Khan, Shahnaz Shah Firdaus

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