Cost-effectiveness of haemodialysis and peritoneal dialysis for patients with end-stage renal disease in Singapore

Fan Yang, Titus Wai Leong Lau, Nan Luo

    Research output: Contribution to journalArticlepeer-review

    Abstract

    AIM: 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. This article is protected by copyright. All rights reserved.

    Original languageEnglish
    Pages (from-to)669–677
    JournalNephrology
    Volume21
    Issue number8
    Early online date13 Nov 2015
    DOIs
    Publication statusPublished - Aug 2016

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