TY - JOUR
T1 - Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia
AU - Afiatin,
AU - Khoe, Levina Chandra
AU - Kristin, Erna
AU - Masytoh, Lusiana Siti
AU - Herlinawaty, Eva
AU - Werayingyong, Pitsaphun
AU - Nadjib, Mardiati
AU - Sastroasmoro, Sudigdo
AU - Teerawattananon, Yot
N1 - Funding Information:
This work received funding support from the state budget from the Ministry of Health, Indonesia and the Australian Indonesian Partnership for Health Systems Strengthening (AIPHSS) under the Department of Foreign Affairs Trade, Australia. Technical assistance from the Health Intervention and Technology Assessment Program (HITAP) International Unit was supported by International Decision Support Initiative (iDSI) to provide technical assistance on health intervention and technology assessment to governments in low- and middle-income countries. iDSI is funded by the Bill and Melinda Gates Foundation, the UK's Department for International Development, and the Rockefeller Foundation. The HITAP team provided technical assistance to the authors throughout the conduct of the research, the writing of the report, and the publication process. The other funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This paper is an output of a study carried out under the auspices of Indonesian Health Technology Assessment Committee (InaHTAC), coordinated by the Center of Health Financing and Security, Ministry of Health. The authors are thankful to all staff in the Department of Economic Evaluation and Health Financing (EEPK), the Center of Health Financing and Security (PPJK); the ad hoc panel, i.e. Prof. Suhardjono, Prof. Rully Roesli, Prof. Budi Hidayat, Dr. Ahmad Fuady, Dr. Agusdini, Ully Adhien; Indonesian Renal Registry, Prof. Hasbullah Thabrany, Septiara Putri, and the PIC team. This paper was produced in partnership with HITAP as part of the International Decision Support Initiative (iDSI, http://www.idsihealth.org), a global initiative to support decision-makers in priority-setting for universal health coverage.
Publisher Copyright:
© 2017 Afiatin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2017/5
Y1 - 2017/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85019371927&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0177436
DO - 10.1371/journal.pone.0177436
M3 - Article
C2 - 28545094
AN - SCOPUS:85019371927
VL - 12
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 5
M1 - e0177436
ER -