Table 2 Cost-effectiveness findings of studies included.
Author (Year of publication) | Comparator | Intervention | WTP-Threshold | Results | Estimated INB | Conclusion and recommendation | |
|---|---|---|---|---|---|---|---|
Pairwise approach-based studies | |||||||
1. | Yang et al. [2021] 10 | HD | PD (5 years) | US$ 44,300 | At a WTP-threshold of US$ 44,300, KT was most cost-effective compared to PD. At an ICER of US$ 35,518, PD was preferential to HD | 14.68 | The planning for KRT service delivery should incorporate efforts to increase the future utilization of KT and PD |
HD | PD (10 years) | 24.05 | |||||
HD | PD (15 years) | 28.69 | |||||
HD | KT (5 years) | 75.04 | |||||
HD | KT (10 years) | 140.06 | |||||
HD | KT (15 years) | 188.40 | |||||
PD | KT (5 years) | 60.36 | |||||
PD | KT (10 years) | 116.01 | |||||
PD | KT (15 years) | 159.71 | |||||
2. | Moradpour et al. [2020] 11 | HD | PD | US$ 12,400 | KT is more cost-effective compared to PD (ICER US$ 1446 per QALY). PD was preferential to HD | −12.76 | Efforts required to encourage living kidney donation and potential recruitment of brain-dead donors. Promote PD as a superior alternative to HD for eligible patients |
HD | KT | 47.05 | |||||
PD | KT | 32.78 | |||||
3. | Rosselli et al. [2015] 47 | HD | KT | US$ 20,000 | KT was more cost-effective compared to dialysis from the second year (ICER US$ 11,788). It became the preferential alternative after the fourth year | 27.33 | Health systems should support programs that encourage KT over dialysis for patients with ESKD |
4. | Jensen et al. [2014] 43 | HD | KT | Not reported | KT was preferential as it yielded both lower costs (US$ 107,154 versus US$ 136,559) and better outcomes (4.4 QALY versus 1.7 QALY) compared to dialysis | 446.06 | KT should be prioritized over dialysis. Promotion to use kidneys from living donors |
5. | Kontodimopoulos et al. [2008] 44 | HD | PD | Not reported | KT was most cost-effective. The cost per QALY was higher in HD (US$ 87,342) compared to PD (US$ 78,877) and KT (US$ 65,880) | 37.83 | Initiation of a campaign to promote organ donation. After KT, promoting PD appears to be the next best option |
HD | KT | 775.69 | |||||
PD | KT | 737.87 | |||||
6. | Arredondo et al. [1998] 48 | HD | PD | Not reported | The most cost-effective intervention was KT (US$ 3088) followed by CAPD (US$ 6416) and HD (US$ 11,147) | 26.40 | Promotion of KT as the most cost-effective intervention for patients with ESKD |
HD | KT | 50.50 | |||||
PD | KT | 24.10 | |||||
7. | Sesso et al. [1990] 49 | HD | CAPD | Not reported | CAPD was less cost-effective than HD and both were less cost-effective than KT. The cost per year of survival was CAPD US$ 12,134, HD US$ 10,065, CD-KT US$ 6978 and LD-KT US$ 3022 | −557.96 | Although KT alternatives were reported to be more cost-effective, the dialysis alternatives had better survival rates |
CAPD | Cadaveric KT | −816.76 | |||||
HD | Living Donor KT | −1701.61 | |||||
HD | Cadaver KT | −1374.72 | |||||
Scenario-based studies | |||||||
1. | Yang et al. [2021] 10 | Current Scenario 1: HD 73%, PD 14%, KT 13% | Scenario 2: Increase in incident patients on PD, i.e., HD 47%; PD 40%; KT 13% | US$ 44,300 | Scenario 2 was preferential to scenario 1. Scenarios 3&4 were cost-effective (4 more than 3) compared with scenario 1. The results were consistent across three time-horizons; 5, 10 and 15 years | 52,218.92 | Increasing the proportion of incident patients on PD was preferential. Increasing the number of patients on both PD and KT resulted in an ICER below the threshold |
Scenario 3: Increase in incident patients on RT, i.e., HD 52%; PD 14%; KT 34% | 213,211.30 | ||||||
Scenario 4: Increase in both PD and KT, i.e., HD 26%; PD 40%; KT 34% | 265,431.67 | ||||||
2. | Bayani et al. [2021] 18 | Current scenario 1: 94% patients on HD—2 sessions/ week (90 sessions covered) 4% PD, 2% KT | Scenario 2: PD-first policy—11% HD, 87% of incident patients on PD, 2% KT. | US$ 7720. | All policy options were above the threshold, therefore not cost-effective. Scenario 2 (PD-first policy) had the least ICER (US$ 29,338), followed by Scenario 4 (US$ 29,747) then Scenario 5 (US$ 78,355) | −249.49 | Shifting to a PD-first policy instead of expanding current HD coverage was the best strategy to make KRT affordable and sustainable for the health system |
Scenario 4: PD-first and pre-emptive transplant—No HD, PD 90% & the rest i.e., 10% are given KT upon diagnosis of ESKD. | −86.53 | ||||||
Scenario 5: Adequate HD—Expansion of HD coverage to 156 sessions/year to cover treatment thrice/ week, 4% PD, 2% KT. | −89.68 | ||||||
3. | Villa et al. [2012] 19 | Current situation of the Spanish KRT program: HD 46%, PD 5%, KT 49% | Scenario 2: increased proportion of scheduled patients on PD from 10–30%, | US$ 48,011 | Scenario 1 was the least preferential. Scenarios 2 and 5b were the most cost-effective. The ICERs of scenarios 5a, 2, and 5b, compared with scenario 1, were US$ −114,060, US$ −486,936, and US$ −323,574 per QALY respectively | 0.25 | An increase in the overall scheduled incidence of KRT, and particularly that of PD, should be promoted |
Scenario 5a: increased proportion of overall scheduled incident patients from 57–75% | 1.24 | ||||||
Scenario 5b: combined scenarios 2 and 3 | 1.27 | ||||||
4. | Shimizu et al. [2012] 50 | Current scenario 1 Base composition of KRT: 96.8% HD | Scenario 2: Likelihood of starting with PD increased by 2.3-times | US $50,000 | Compared to the base scenario, the most cost-effective KRT was scenario 3b, followed by scenario 3a and 3c, (all three were preferential), then scenario 2 | 13.68 | KT uptake should be promoted as more cost-effective |
Scenario 3a: Likelihood of a pre-emptive living donor transplant increased by 2.4-times | 21.1 | ||||||
Scenario 3b: Likelihood of a living donor transplant increased by 2.4-times | 36.03 | ||||||
Scenario 3c: Likelihood of a deceased donor transplant increased by 22-times | 20.37 | ||||||
5. | Haller et al. [2011] 46 | Scenario 1: 90.6% of incident ESKD patients HD, PD 7.2%, LDKT 0.1%, DDKT 2.1% | Scenario 2: 20% of the incident ESKD patients were allocated to PD. | Not reported | Scenario 1 was less preferential to Scenario 2 & 4. Scenario 2 saved US$31 million and gained 839 QALYs; Scenario 4 saved US$46 million and gained 2242 QALYs | 104,608.60 | Live-donor KT is cost-effective and associated with increase in QALYs. Preemptive live donor KT should be promoted |
Scenario 4: 20% of incident ESKD patients were allocated to PD and additional 10% for preemptive KT from a living donor. | 279,538.06 | ||||||
6. | Howard et al. [2009] 20 | Current scenario 1: Hospital HD 37.9%, Home HD 5.5%, PD 12.5%, KT 44.1% | Scenario 3a: annual incremental increase in KT to reach an extra 10% by 2010, | Not reported | Scenario 1 was less preferential to Scenario 3a & 3b. Scenario 2 was less costly and at least as effective. Increasing KT had a saving of US$4 million to US$20 million. Increasing PD had a net saving of US$94 million | 19,999.87 | KT increases survival and is most cost-effective. Moving people away from hospital-based to home-based dialysis is associated with lower costs |
Scenario 3b—annual incremental increase in KT to reach an extra 50% by 2010. | 95,521.04 | ||||||
7. | de Wit et al. [1998] 45 | Scenario 1: base case—30 KT per million population + the other modalities | Scenario 2a: 10% of new CHD patients to CAPD | Not reported | When comparing dialysis modalities to each other, the ratio of cost/LY gained and cost/QALY was best for CAPD and worst for center-HD | 46,627.09 | KT and CAPD were the most cost-effective options, while center-HD was the least cost-effective option |
Scenario 2b: 20% of new CHD patients to CAPD | 93,346.85 | ||||||
Scenario 3a: 38 KT per million population | 87,503.85 | ||||||
Scenario 3b: 44 KT per million population | 203,530.52 | ||||||
