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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.

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



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.


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.


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.


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.

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