Economic evaluation of dialysis and comprehensive conservative care for chronic kidney disease using the ICECAP-O and EQ-5D-5L; a comparison of evaluation instruments

Zahirian Moghadam, Telma; Powell, Jane; Sharghi, Afshan; Zandian, Hamed

Abstract

Background: Chronic Kidney Disease (CKD) patients often require long-term care, and while Hemodialysis (HD) is the standard treatment, Comprehensive Conservative Care (CCC) is gaining popularity as an alternative. Economic evaluations comparing their cost-effectiveness are crucial. This study aims to perform a cost-utility analysis comparing HD and CCC using the EQ-5D-5L and ICECAP-O instruments to assessing healthcare interventions in CKD patients. Methods: This short-term economic evaluation involved 183 participants (105 HD, 76 CCC) and collected data on demographics, comorbidities, laboratory results, treatment costs, and HRQoL measured by ICECAP-O and EQ-5D-5L. Incremental Cost-Effectiveness Ratios (ICERs) and Net Monetary Benefit (NMB) were calculated separately for each instrument, and Probabilistic Sensitivity Analysis (PSA) assessed uncertainty. Results: CCC demonstrated significantly lower costs (mean difference $8,544.52) compared to HD. Both EQ-5D-5L and ICECAP-O indicated higher Quality-Adjusted Life Years (QALYs) for both groups, but the difference was not statistically significant (p > 0.05). CCC dominated HD in terms of HRQoL measures, with ICERs of -$141,742.67 (EQ-5D-5L) and -$4,272.26 (ICECAP-O). NMB was positive for CCC and negative for HD, highlighting its economic feasibility. Conclusion: CCC proves a preferable and more cost-effective treatment option than HD for CKD patients aged 65 and above, regardless of the quality-of-life measure used for QALY calculations. Both EQ-5D-5L and ICECAP-O showed similar results in cost-utility analysis.

• Journal Article Type: Article
• Acceptance Date: Oct 24, 2023
• Online Publication Date: Nov 3, 2023
• Publication Date: Nov 3, 2023
• Deposit Date: Nov 8, 2023
• Publicly Available Date: Nov 17, 2023
• Journal: Cost Effectiveness and Resource Allocation
• Electronic ISSN: 1478-7547
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 1
• Article Number: 81
• DOI: https://doi.org/10.1186/s12962-023-00491-3
• Keywords: Cost-effectiveness analysis, Dialysis, Comprehensive conservative care, Chronic kidney disease, Quality of life, Elderly
• Public URL: https://uwe-repository.worktribe.com/output/11416981
• Additional Information: Received: 29 August 2023; Accepted: 24 October 2023; First Online: 3 November 2023; : ; : This study has been approved by the ethical committee of University of Medical Sciences with the code IR.ARUMS.REC.1400.032 where they approved that all methods of this study were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants before data collection.; : Not applicable.; : The authors declare that they have no competing interests.