Kidney Disease-Specific Scores and Health Utility of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients and Their Caregivers.

OBJECTIVES: This study aimed to compare the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L), the visual analogue scale (VAS), and the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) scores of Thai continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients and to compare the utility scores with the EQ-5D-5L and VAS scores of caregivers. METHODS: This was a cross-sectional study completed between April 2016 and May 2017. In total, 34 CAPD patients, 30 APD patients, and their caregivers were recruited from a large university hospital in Thailand. A trained interviewer conducted face-to-face interviews. We collected demographic data and used the KDQOL-36 and EuroQol questionnaires (EQ-5D-5L and VAS) to assess the health-related quality of life. Caregivers were asked to assess their own health status using the EQ-5D-5L and VAS. RESULTS: The EQ-5D-5L and VAS responses of the CAPD and APD patients and their caregivers were not significantly different (P > .05). More than 50% of both patient groups had mobility problems, whereas most patients had no problems with self-care, doing usual activities, pain or discomfort, and anxiety or depression. As for the KDQOL-36, the physical and mental component summaries were not significantly different, and neither were the scores for all of the kidney disease-specific dimensions, including symptoms or problems, effects of kidney disease, and burden of kidney disease (all were P > .05). CONCLUSIONS: The results indicated that the quality of life of CAPD and APD patients and their caregivers were mostly equivalent. A further longitudinal study of utility score assessments of the differences in modality would be advantageous.

Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai Patients With End-Stage Renal Disease.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is the first option for patients with end-stage renal disease under the benefit package of Thailand. Nevertheless, automated peritoneal dialysis (APD) may benefit these patients in terms of both medical and quality-of-life aspects, but it is more expensive. The economic evidence for the comparison between CAPD and APD is not inconclusive. Thus, this study aims to evaluate the cost-effectiveness of CAPD compared with APD in PD patients. OBJECTIVES: To assess the health-related quality of life and costs between patients treated with CAPD and APD. METHODS: A Markov model was developed to evaluate the cost-effectiveness of CAPD and APD from the societal perspective. Costs and outcomes were calculated over a lifetime horizon and discounted at an annual rate of 3%. The outcomes were presented as quality-adjusted life-years (QALYs) of CAPD and APD. Utility scores were calculated from the utility values of the 5-level EuroQol questionnaire. A probabilistic sensitivity analysis using 5000 Monte Carlo simulations was performed to evaluate the stability of the results. RESULTS: The costs of APD and CAPD were 12 868 080 and 11 144 786 Thai baht, respectively, whereas the QALYs were 24.28 and 24.72 QALYs, respectively. APD was more costly but less effective than CAPD. The most sensitive parameter was direct medical cost of outpatient visits. When the willingness-to-pay threshold was 160 000 Thai baht per QALY, the probability of APD providing a cost-effective alternative to CAPD was 19%. CONCLUSION: APD was not a cost-effective strategy as compared with CAPD at the current Thai threshold. These findings should encourage clinicians and policy makers to encompass the use of CAPD as a good value for money for PD treatment.

Comparison of EQ-5D-5L, VAS, and SF-6D in Thai Patients on Peritoneal Dialysis.

OBJECTIVES: To compare the utility scores derived from the 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L), the visual analogue scale (VAS), and the 6-dimensional health state short form (SF-6D) in Thai patients on peritoneal dialysis. METHODS: Data were obtained from the 36-Item Kidney Disease Quality of Life questionnaire and the EuroQol questionnaires (EQ-5D-5L and VAS) via face-to-face interview for 64 patients on peritoneal dialysis. We compared the ceiling effect of all the utility tools by calculating the proportion at the highest scores. The mean difference in utility scores defined by patients' demographic characteristics and clinical laboratory value was evaluated using independent t tests or the Mann-Whitney U test. Moreover, the correlation was assessed using the Pearson correlation coefficient. The agreements among the instruments were illustrated with the Bland and Altman plots. RESULTS: The mean score of the EQ-5D-5L, SF-6D, and VAS were 0.801, 0.784, and 0.733, respectively. The EQ-5D-5L presented a higher percentage of the ceiling effect than did the SF-6D and VAS. The EQ-5D-5L was able to distinguish the mean difference between age groups with significant difference (P<.001). The Pearson correlation coefficients between utility scores and the 3 dimensions of the 36-Item Kidney Disease Quality of Life questionnaire had a significantly positive correlation, especially for the SF-6D. The Bland and Altman plots portrayed that the utility scores from the EQ-5D-5L were lower than those from the SF-6D and VAS among the patients in the poorer health state. CONCLUSIONS: Among the SF-6D, EQ-5D-5L, and VAS, only the EQ-5D-5L could distinguish the utility scores between different age groups. Nevertheless, the EQ-5D-5L presented the ceiling effect, whereas there was no evidence of the ceiling effect for the SF-6D. The SF-6D presented better correlation with the kidney disease-specific dimensions than did the EQ-5D-5L and VAS. Thus, the advantages and disadvantages of each utility tool should be considered.

Comparison on Human Resource Requirement between Manual and Automated Dispensing Systems.

OBJECTIVE: This study was conducted to compare human resource requirement among manual, automated, and modified automated dispensing systems. METHODS: Data were collected from the pharmacy department at the 2100-bed university hospital (Siriraj Hospital, Bangkok, Thailand). Data regarding the duration of the medication distribution process were collected by using self-reported forms for 1 month. The data on the automated dispensing machine (ADM) system were obtained from 1 piloted inpatient ward, whereas those on the manual system were the average of other wards. Data on dispensing, returned unused medication, and stock management processes under the traditional manual system and the ADM system were from actual activities, whereas the modified ADM system was modeled. The full-time equivalent (FTE) of each model was estimated for comparison. RESULTS: The result showed that the manual system required 46.84 FTEs of pharmacists and 132.66 FTEs of pharmacy technicians. By adding pharmacist roles on screening and verification under the ADM system, the ADM system required 117.61 FTEs of pharmacists. Replacing counting and filling medication functions by ADM has decreased the number of pharmacy technicians to 55.38 FTEs. After the modified ADM system canceled the return unused medication process, FTEs requirement for pharmacists and pharmacy technicians decreased to 69.78 and 51.90 FTEs, respectively. CONCLUSIONS: The ADM system decreased the workload of pharmacy technicians, whereas it required more time from pharmacists. However, the increased workload of pharmacists was associated with more comprehensive patient care functions, which resulted from the redesigned work process.

Cost-Utility Analysis of Erythropoietin for Anemia Treatment in Thai End-Stage Renal Disease Patients with Hemodialysis.

OBJECTIVE: To compare the cost utility of using erythropoietin (EPO) to maintain different hemoglobin (Hb) target levels in hemodialysis patients from a societal perspective. METHODS: A Markov model was used to estimate the incremental cost and quality-adjusted life-year of five Hb levels: 9 or less, more than 9 to 10, more than 10 to 11, more than 11 to 12, and more than 12 g/dl. A systematic review of EPO treatment in hemodialysis patients was conducted to estimate transitional probabilities. Cost data were estimated on the basis of the reference price of Siriraj Hospital, the largest university hospital in Thailand. Utility scores were derived from the six-dimensional health state short form (derived from short-form 36 health survey), which were collected from 152 hemodialysis patients receiving EPO at Siriraj hospital. Probabilistic sensitivity analysis was conducted to investigate the effect of uncertain parameters. All future costs and outcomes were discounted at the rate of 3% per annum. RESULTS: The incremental cost-effectiveness ratios of Hb levels more than 9 to 10, more than 10 to 11, more than 11 to 12, and more than 12 g/dl compared with the least costly option (Hb ≤ 9 g/dl) were US $24,128.03, US $18,789.07, US $22,427.36, and US $28,022.33 per quality-adjusted life-year, respectively. From probabilistic sensitivity analysis, the hemoglobin level of more than 10 to 11 g/dl was appropriate when the willingness to pay was US $15,523.88 to US $46,610.17 and the probability of cost-effective was 29.32% to 95.94%. CONCLUSIONS: Providing EPO for a hemoglobin level of more than 10 to 11 g/dl had a cost-effectiveness higher than that of doing so for other hemoglobin levels. This finding will be put forward to the policy level to set up the EPO treatment guideline of the hospital for hemodialysis patients.