Cost effectiveness analysis of erythropoietin therapy in the ministry of health dialysis programme
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Date
2006
Authors
Md. Yusof, Faridah Aryani
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Volume Title
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Abstract
End-stage renal failure patients are normally anaemic due to failure of renal to
produce endogenous erythropoietin (EPO). Erythropoietin is used to treat
anaemia in these patients but the drug is expensive. The drug is also used in
cancer and thalassemia patients and it makes EPO in high demand and thus
increasing the budget for the government. The objectives of this study were to
determine the life expectancy, the improvement in haemoglobin levels of
anaemic patients associated with EPO therapy, the improvement in quality of
life associated with haemoglobin, the utility oi the dialysis patients, the
additional costs associated with EPO therapy and the cost effectiveness of
MOH dialysis program, measured as cost per quality-adjusted life year saved.
The instruments used for health-related quality of life questionnaires were EQ-
50 and Spitzer's quality of life index, and also the time trade-off method. The
costs were valued in terms of year 2004 RM. The National Renal Registry
(NRR) database for period 1997- 2004 formed the basis of patient selection,
where data was not available the NRR database was used as the sampling
frame to obtain the list of patients for the survey. Erythropoietin therapy
improved the mean haemoglobin level of anaemic haemodialysis patients by
9.39% (8.97 g/dl to 9.81 g/dl) and CAPO patients 8.48% (8.96 g/dl to 9.72 g/dl)
at the range of 8 to 1 0 g/dl. Mean dose of EPO prescribed at baseline
haemoglobin level between 8 to 10 g/dl was 4679 U per week for haemodialysis
patients and 44 77 U per week for CAPO patients. The mean cost to raise 1 g/dl
haemoglobin per patient per year was RM527 4 for haemodialysis patients and
RM4887 for CAPO patients at same haemoglobin levels.
Overall life expectancy on dialysis was 10.13 years with superior life
expectancy for haemodialysis (11.37 years) compared to CAPO. (7.94 years).
Age at commencement of dialysis, diabetic status, haemoglobin level, albumin
level and dialysis modality were significant predictors of life expectancy. Quality
of life of CAPO patients was higher among the dialysis patients (0.79 to 0.93) of
perfect health equivalent compared to haemodialysis patients (0.79 to 0.89) of
perfect health equivalent. The cost of dialysis was RM33,958 for haemodialysis
and RM33,243 for CAPO per patient per year. The cost per quality-adjusted life
years was RM43,000 for haemodialysis and • RM41 ,000 for CAPO. The
incremental QAL Ys gained for haemodialysis and CAPO patients at
ha~moglobin baseline were 2.04 and 0.27, respectively. The incremental cost
per QALY gained of EPO was RM66,000 and RM137,000 for haemodialysis
and CAPO patients, respectively at the same average baseline haemoglobin
level between 8 g/dl and 10 g/dl. In conclusion, haemodialysis is more cost
effective modality with the current state of utilisation of EPO therapy.
Keywords: Haemodialysis, Continuous Ambulatory Peritoneal Dialysis,
Erythropoietin, Anaemia, Cost-effectiveness, Quality of Life, TTO, Qualityadjusted
Life Years, Ministry of Health
Description
Keywords
Erythropoietin therapy , Health dialysis