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Cost-effectiveness analysis of the Spanish renal replacement therapy program
Guillermo Villa1, Lucía Fernández-Ortiz, Jesús Cuervo
1BAP Health Outcomes Research1 and Department of Medicine, Universidad de Oviedo, Oviedo, Spain. guillermo@baphealth.com
Summary
Promoting peritoneal dialysis (PD) within Spain's Renal Replacement Therapy (RRT) program offers significant cost savings and improved patient outcomes. Increased PD utilization in RRT is cost-effective for end-stage renal disease patients.
Area of Science:
- Health Economics
- Nephrology
- Public Health Policy
Background:
- Cost-effectiveness analysis of Spain's Renal Replacement Therapy (RRT) program for end-stage renal disease (ESRD) patients.
- Societal perspective analysis comparing current RRT practices with hypothetical scenarios.
Purpose of the Study:
- To evaluate the cost-effectiveness of different scenarios for the Spanish RRT program.
- To identify optimal strategies for managing ESRD patients.
Main Methods:
- Markov chain modeling used for simulations over 5, 10, and 15-year horizons.
- Comparison of current RRT scenario (Scenario 1) with three alternative scenarios involving increased planned patient incidence and peritoneal dialysis (PD) utilization.
- Analysis of incremental cost-effectiveness ratios (ICERs) and net health benefits.
Main Results:
- All proposed scenarios demonstrated cost savings and effectiveness gains compared to the current Spanish RRT situation.
- Scenarios 3 and 4, emphasizing increased PD incidence, showed the most favorable cost-effectiveness.
- Estimated ICERs ranged from -€83,150 to -€354,977 per incremental quality-adjusted life year (ΔQALY).
Conclusions:
- The current Spanish RRT program is outperformed by scenarios promoting increased planned RRT incidence, especially PD.
- Increased utilization of PD within the RRT program is recommended from a cost-effectiveness standpoint.
- Policy should encourage higher incidence of RRT, with a specific focus on promoting PD.
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