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Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study

Authors Takura T, Hiramatsu M, Nakamoto H, Kuragano T, Minakuchi J, Ishida H, Nakayama M, Takahashi S, Kawanishi H

Received 20 April 2019

Accepted for publication 20 August 2019

Published 25 September 2019 Volume 2019:11 Pages 579—590


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Dean Smith

Tomoyuki Takura,1 Makoto Hiramatsu,2 Hidetomo Nakamoto,3 Takahiro Kuragano,4 Jun Minakuchi,5 Hironori Ishida,6 Masaaki Nakayama,7 Susumu Takahashi,8 Hideki Kawanishi9

1Department of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Outpatient Center Hospital, Okayama Saiseikai General Hospital, Okayama City, Okayama, Japan; 3General Intrarenal Medicine, Saitama Medical University, Saitama, Japan; 4Internal Medicine (Nephrology and Dialysis), Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan; 5Nephrology (Endocrinology), Kawashima Hospital, Tokushima City, Tokushima, Japan; 6Urology, Kitasaito Hospital, Asahikawa City, Hokaido, Japan; 7Kidney Center, St. Luke’s International Hospital, Tokyo, Japan; 8Head Office, International Kidney Evaluation Association Japan, Tokyo, Japan; 9Artificial Organs and Surgery, Tsuchiya General Hospital, Hiroshima City, Hiroshima, Japan

Correspondence: Tomoyuki Takura
Department of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tel +81 35 800 9523
Fax +81 35 800 9156

Background: In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated.
Methods: This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases.
Results: The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY.
Conclusion: The cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the “PD first” concept.

Keywords: diabetic nephropathy, cost-utility analysis, quality-adjusted life year, medical service reimbursement, automated peritoneal dialysis, propensity score

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