Journal Article

Economic evaluation of dialysis treatment in end-stage renal disease patients with fluid and sodium overload: Evidence from a randomized controlled trial in Thailand

Yoopetch, Panida, Sritippayawan, Suchai, Chaikledkaew, Usa, Thavorncharoensap, Montarat, Youngkong, Sitaporn, Assanatham, Montira

2025

Overview

Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Blood pressure / Care and treatment / Chronic kidney failure / Clinical outcomes / Clinical trials / Comparative analysis / Cost analysis / Cost effectiveness / Cost-Benefit Analysis / Decision making / Dextrose / Diagnosis / Dialysate / Dialysis / Economic aspects / Economics / Edema / End-stage renal disease / Evaluation / Female / Glucose / Health care expenditures / Hemodialysis / Hospitals / Humans / Icodextrin / Kidney diseases / Kidney Failure, Chronic - economics / Kidney Failure, Chronic - therapy / Male / Markov Chains / Markov processes / Medical care, Cost of / Medical economics / Middle Aged / National health insurance / Overloading / Patients / Peritoneal dialysis / Peritoneal Dialysis, Continuous Ambulatory - economics / Peritoneal Dialysis, Continuous Ambulatory - methods / Peritoneum / Quality of life / Quality-Adjusted Life Years / Renal Dialysis - economics / Sodium / Sodium - metabolism / Thailand