RESUMO
BACKGROUND: A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. METHODS: A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. RESULTS: Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 , compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 /QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 /QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). CONCLUSIONS: Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients' survival rates and health-related quality of life at an affordable cost. Spanish Public Health authorities might therefore promote the inclusion of specific recommendations for this group of patients within the existing clinical guidelines.
Assuntos
Falência Renal Crônica/terapia , Transplante de Rim , Encaminhamento e Consulta/economia , Diálise Renal/economia , Adulto , Análise Custo-Benefício , Eficiência Organizacional , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/diagnóstico , Transplante de Rim/mortalidade , Transplante de Rim/estatística & dados numéricos , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Estatísticos , Anos de Vida Ajustados por Qualidade de Vida , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Diálise Renal/normas , Sensibilidade e Especificidade , Espanha , Fatores de Tempo , Falha de TratamentoRESUMO
BACKGROUND: A cost analysis of the Spanish Renal Replacement Therapy (RRT) programme in the year 2010, for end-stage renal disease (ESRD) patients, was performed from the perspective of the Public Administration. METHODS: The costs associated with each RRT modality [hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (Tx)] were analysed. The Spanish ESRD incidence and prevalence figures in the year 2010 were forecasted in order to enable the calculation of an aggregate cost for each modality. Costs were mainly computed based on a review of the existing literature and of the Official Bulletins of the Spanish Autonomous Communities. Data from Oblikue Consulting eSalud health care costs database and from several Spanish public sources were also employed. RESULTS: In the year 2010, the forecasted incidence figures for HD, PD and Tx were 5409, 822 and 2317 patients, respectively. The forecasted prevalence figures were 22,582, 2420 and 24,761 patients, respectively. The average annual per-patient costs (incidence and prevalence) were 2651 and 37,968 (HD), 1808 and 25,826 (PD) and 38,313 and 6283 (Tx). Indirect costs amounted to 8929 (HD), 7429 (PD) and 5483 (Tx). The economic impact of the Spanish RRT programme on the Public Administration budget was estimated at ~1829 million (indirect costs included): 1327 (HD), 109 (PD) and 393 (Tx) million. CONCLUSIONS: HD accounted for >70% of the aggregate costs of the Spanish RRT programme in 2010. From a costs minimization perspective, it would be preferable if the number of incident and prevalent patients in PD were increased.
Assuntos
Falência Renal Crônica/economia , Terapia de Substituição Renal/economia , Custos e Análise de Custo , Custos de Cuidados de Saúde , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Prevalência , Espanha/epidemiologia , População BrancaRESUMO
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.