COST-EFFECTIVENESS ANALYSIS OF DIALYSIS AND KIDNEY TRANSPLANTATION TREATMENT IN TURKEY

Yıl 2015, Cilt: 1 Sayı: 13, 182 - 205, 11.01.2016

Vahit Yiğit , Ramazan Erdem

Öz

The purpose of this study is to confirm the cost effectiveness of hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (Tx) which are used for renal failure treatment with perspective of Social Security Instution (SSI) as well as confirm the alternative treatment methods’ amount consumed in budget. This research was conducted in 2013 at Akdeniz University Hospital. These treatment methods’ cost, life year and quality adjusted life year (QALY) were calculated by using Markov model and results were reduced by 3%. One-way sensitivity analysis was made for evaluating the effect of discount rate and study’s time period. Finally, to determine how the resource consumption of these treatments for budget impact analysis was conducted. In this study confirmed that a patient’s cost of HD is 29.592 TL, cost of PD is 29.061 TL, cost of Tx is 51.279 TL in first year of transplantation and 8.654 TL in second and the other years. Alternative treatment methods’ effectiveness values were evaluated with EQ-5D-5L scale. HD effectiveness value was confirmed as 0.6832, PD value was confirmed as 0.7092 and Tx value was confirmed as 0.8929. According to the markov model’s results, cost per patient of HD is 305.591 TL cost of PD is 322.895-TL and cost of Tx is 217.259 TL. HD QALY value is 6.63, PD QALY value is 8.02 and Tx QALY value is 13.00. According to markov model results; in one-year lifetime cost of HD was found as 36.892 TL/YL, cost of PD was found as 29.921 TL/YL and cost of kidney transplantation was found as 14.401 TL/YL. Meanwhile per QALY cost of HD was found as 46.105 TL/QALY, cost of PD was found as 40.274 TL/QALY and cost of Tx was found as 16.714 TL/QALY. According to cost-effectiveness analysis result when Tx was compared with HD, Tx provides incremental cost as 6.37 QALY and (-) 88.332,44 TL. Incremental Cost-Effectiveness Ratio (ICER) of Tx was calculated as (-) 13.865 TL per acquired QALY. When Tx was compared with PD, Tx provides incremental cost as 4.98 QALY and (-) 105.637 TL. ICER of Tx was calculated as (-) 21.207 TL per acquired QALY. Because of ICER is below the threshold in cost-effectiveness analysis, Tx is cost-effective both regarding to HD and PD. These three treatment methods’ financial charge is 2.047.633.644 TL in annual budget (2012) in Turkey. 4.64 % of SSI total health expenditure is estimated to be spent on HD, PD and Tx treatment.  

Anahtar Kelimeler

Cost-Effectiveness Analysis, Hemodialysis, Peritoneal Dialysis, Kidney Transplantation

TÜRKİYE'DE DİYALİZ VE BÖBREK TRANSPLANTASYONU TEDAVİSİNİN MALİYET ETKİLİLİK ANALİZİ

Öz

Bu araştırmanın amacı, son dönem böbrek yetmezliği tedavisinde uygulanan hemodiyaliz (HD), periton diyalizi (PD) ve böbrek transplantasyonu (Tx) tedavi yöntemlerinin Sosyal Güvenlik Kurumu (SGK) perspektifinden maliyet etkililiğini ve bu yöntemlerin bütçeden ne kadar kaynak tükettiğini tespit etmektir.. Araştırmada Markov modeli kullanılarak bu tedavi yöntemlerinin maliyeti, yaşam yılı ve kaliteye ayarlanmış yaşam yılı hesaplanmış ve hesaplanan sonuçlara %3 indirgeme yapılmıştır. Çalışmanın kapsadığı zaman dilimi ve iskonto oranının sonuçlara etkisini değerlendirmek için tek yönlü duyarlılık analizi yapılmıştır. Son olarak bu tedavilerin ne kadar kaynak tüketimini tespit etmek için bütçe etki analizi yapılmıştır. Araştırma sonuçlarına göre Markov modelinde belirlenen zaman diliminde hasta başına maliyet HD, PD ve Tx sırasıyla; 305.591-TL, 322.895-TL ve 217.259-TL; QALY değerleri ise HD 6.63, PD 8.02, Tx ise 12.99 olarak saptanmıştır. Araştırmada Markov modelinden elde edilen sonuçlara göre bir yıllık yaşam süresinde HD 36.892 TL/YL, PD 29.921 TL/YL ve Tx 14.401 TL/YL maliyet tespit edilirken QALY başına maliyet ise HD 46.105 TL/QALY, PD 40.274 TL/QALY ve Tx 16.714 TL/QALY olarak hesaplanmıştır. Maliyet etkililik analizi sonucuna göre Tx ile HD karşılaştırıldığında 6.37 QALY ve (-) 88.332 TL ilave maliyet sağlamaktadır. Maliyet etkililik analizinde ICER’ın eşik değerin çok altında olması nedeni ile Tx hem HD, hem de PD göre maliyet etkili olarak bulunmuştur. Markov modelinden elde edilen verilere göre SGK toplam sağlık harcamalarının ise %4.64’ünün RRT yöntemlerine harcandığı tahmin edilmektedir.

Anahtar Kelimeler

maliyet etkililik analizi, hemodiyaliz, periton diyalizi, böbrek transplantasyonu

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