Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia

Abstract

ObjectivesThis study aims to assess the value for money and budget impact of offering hemodialysis (HD) as a first-line treatment, or the HD-first policy, and the peritoneal dialysis (PD) first policy compared to a supportive care option in patients with end-stage renal disease (ESRD) in Indonesia.MethodsA Markov model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). Three policy options were compared, i.e., the PD-first policy, HD-first policy, and supportive care.ResultsThe PD-first policy for ESRD patients resulted in 5.93 life years, equal to the HD-first policy, with a slightly higher QALY gained (4.40 vs 4.34). The total lifetime cost for a patient under the PD-first policy is around 700 million IDR, which is lower than the cost under the HD-first policy, i.e. 735 million IDR per patient. Compared to supportive care, the incremental cost-effectiveness ratio of the PD-first policy is 193 million IDR per QALY, while the HD-first policy resulted in 207 million IDR per QALY. Budget impact analysis indicated that the required budget for the PD-first policy is 43 trillion IDR for 53% coverage and 75 trillion IDR for 100% coverage in five years, which is less than the HD-first policy, i.e. 88 trillion IDR and 166 trillion IDR.ConclusionsThe PD-first policy was found to be more cost-effective compared to the HD-first policy. Budget impact analysis provided evidence on the enormous financial burden for the country if the current practice, where HD dominates PD, continues for the next five years.

Utilization of peritoneal dialysis in the United States: Reasons for underutilization, specifically in New York State and the boroughs of New York City

“…A cost‐effectiveness comparison of “HD‐first” vs “PD‐first” policy was conducted in Indonesia. The comparison revealed that an HD‐first policy would cost more than twice the cost of a PD‐first policy, but only after 5 years with quality‐adjusted life years scores favoring PD . A PD‐first policy has been advocated by some groups in the US citing similar benefits …”

“…The comparison revealed that an HD-first policy would cost more than twice the cost of a PD-first policy, but only after 5 years with quality-adjusted life years scores favoring PD. 34 policy has been advocated by some groups in the US citing similar benefits. 35 It has been speculated that the daunting task of learning complex technologies could be playing a factor in non-bachelor-degreed individuals from outlying boroughs.…”

<p>Patient engagement activities with health care professionals in continuous ambulatory peritoneal dialysis therapy: an exploratory pilot study</p>

“…13 The major cost of a renal transplant and dialysis was covered by Jaminan Kesehatan National (JKN), the National Health Insurance Scheme of Indonesia that is managed by the Health Social Security Institution or Badan Penyelenggara Jaminan Sosial (BPJS). 11,14 Patients on HD therapy received dialysis treatments twice in a week with 5 hours for each treatment. Meanwhile for CAPD patients, the government supported the cost of catheter insertion and dialysate for up to four times daily fluid exchange.…”

“…This cost burden caused CKD to be ranked second in Indonesian government spending for catastrophic illness. 14,15 Although renal transplantation was the best therapy for ESRD patients, limited number of kidney donors had made the patients to opt for either HD or CAPD. 12,14 It was estimated that only 53% of ESRD patients in Indonesia were on dialysis, and HD was still the most preferred option of RRT compared to CAPD.…”

“…14,15 Although renal transplantation was the best therapy for ESRD patients, limited number of kidney donors had made the patients to opt for either HD or CAPD. 12,14 It was estimated that only 53% of ESRD patients in Indonesia were on dialysis, and HD was still the most preferred option of RRT compared to CAPD. 14 The 10th Report of Indonesian Renal Registry reported that from 433 HD centers in Indonesia, there were 77,892 HD-active patients covering 98% of active ESRD patients, meanwhile only 2% of the active patients were on CAPD modality at the end of 2017.…”