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PLoS One. 2017 May 18;12(5):e0177436. doi: 10.1371/journal.pone.0177436. eCollection 2017.

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

Author information

1
Department of Internal Medicine, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia.
2
Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
3
Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Gadjah Mada, Jogjakarta, Indonesia.
4
Centre for Health Financing and Security, Ministry of Health, Jakarta, Indonesia.
5
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand.
6
Indonesian Health Technology Assessment Committee, Jakarta, Indonesia.

Abstract

OBJECTIVES:

This 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.

METHODS:

A 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.

RESULTS:

The 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.

CONCLUSIONS:

The 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.

PMID:
28545094
PMCID:
PMC5436694
DOI:
10.1371/journal.pone.0177436
[Indexed for MEDLINE]
Free PMC Article

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