COST-EFFECTIVENESS OF HAEMODIALYSIS AND PERITONEAL DIALYSIS FOR PATIENTS WITH END-STAGE RENAL DISEASE IN SINGAPORE

Purpose:

This study aimed to evaluate the cost-effectiveness of haemodialysis (HD) and two forms of peritoneal dialysis (continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]) for patients with end-stage renal disease (ESRD) in Singapore. 

Method:

A Markov model was developed for patients who started dialysis with HD, CAPD or APD in a time horizon of 10 years. Event data (death, hospitalization, and transplantation) was taken from a hospital database and the national renal registry; health utility data came from published studies of Singaporean dialysis patients, and costs data was obtained from a local hospital and dialysis services providers. Outcome measures were 10-year costs (in 2015 Singaporean dollars [SG$]), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).

The base-case was a hypothetical cohort of 60-year-old non-diabetic ESRD patients who started dialysis with one of the three modalities and had no contradictions to any modality. We performed base-case cost-effectiveness analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis with Monte Carlo simulation. A high-risk group of 60-year-old diabetic ESRD patients was also analyzed.

Result:

The base-case analysis showed that the QALYs were 3.27 with CAPD, 3.48 with APD and 4.69 with HD and the total costs were SG$169,872 for CAPD, 201,509 for APD and 306,827 for HD. The analysis of high risk group showed that the QALYs were 2.50 with CAPD, 2.54 with APD and 3.69 with HD. The total costs were SG$144,972 for CAPD, 169,282 for APD and 271,446 for HD.

For both base-case and high-risk groups, CAPD and HD had extended dominance over APD. The ICER of HD versus CAPD was SG$96,447 per QALY for base-case and 106,281 for high-risk group, respectively.

One-way sensitivity analyses showed that the ICER of HD versus CAPD was most sensitive to the utility for HD for base-case and high-risk groups. Probabilistic sensitivity analysis demonstrated that the probability of CAPD being the optimal choice was 36.2% for the base-case and 44.9% for the high-risk group at a willingness-to-pay threshold of SG$60,000 (US$43,000) per QALY. 

Conclusion:

CAPD may be a cost-effective therapy compared with HD and APD in ESRD patients in Singapore. These findings are potentially useful to all stakeholders of the dialysis services in Singapore.