NDLI: Cost-effectiveness analysis of the Spanish renal replacement therapy program.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Villa, Guillermo Fernández-Ortiz, Lucía Cuervo, Jesús Rebollo, Pablo Selgas, Rafael González, Teresa Arrieta, Javier
Spatial Coverage	Spain
Description	Country affiliation: Spain Author Affiliation: Villa G ( BAP Health Outcomes Research1 and Department of Medicine, Universidad de Oviedo, Oviedo, Spain. guillermo@baphealth.com)
Abstract	BACKGROUND: We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios. METHODS: A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4). RESULTS: The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, - 83 150, - 354 977, and - 235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of 35 000/ΔQALY. CONCLUSIONS: Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.
File Format	HTM / HTML
ISSN	08968608
e-ISSN	17184304
DOI	10.3747/pdi.2011.00037
Journal	Peritoneal Dialysis International
Issue Number	2
Volume Number	32
Language	English
Publisher	Multimed
Publisher Date	2012-03-01
Publisher Place	Canada
Access Restriction	Open
Subject Keyword	Discipline Nephrology Kidney Failure, Chronic Therapy Renal Replacement Therapy Cost-benefit Analysis Markov Chains Models, Biological Spain Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Nephrology

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