COST UTILITY ANALYSIS COMPARING EXPANDED AND HIGH-FLUX HEMODIALYSIS

Introduction:

Expanded hemodialysis (HDx) with greater large middle molecule clearance has been associated with improved clinical and patient reported outcomes. This study aimed to evaluate the cost-utility of the Theranova membrane delivering HDx therapy compared to high-flux (HF) hemodialysis in chronic hemodialysis.

Methods:

This study estimated the cost-utility of the Theranova 400 membrane compared to the HF membrane in hemodialysis, with their outcomes measured in quality-adjusted life years (QALYs) derived from EQ5D-5L. Costs were calculated based on Colombia's 2019 Capitation Payment Unit (UPC) sufficiency database, expressed in US dollars (USD) with an exchange rate of 4,000 Colombian pesos per dollar. The base-case analysis considered a 1-year time horizon per hundred patients, with parameters and variables extracted from existing evidence. The analysis was conducted from the perspective of the third payor. Theranova membrane use was associated with an additional cost of 3,0 US dollars per hemodialysis session, alongside estimated savings from reduced hospitalization rates, ranging from 248 to 706 US dollars per patient-year based on published literature.

Results:

The EQ-VAS index for HDx was 73.4 (SD 20.3) compared to 71.6 (SD 20.7) for HF- HD, a statistically significant difference of 1.8 [95% IC: 0.7 to 3.7] P-value= <0.01. The study found that the Incremental Cost-Utility Ratio (ICUR) was 24,205 US dollars when the higher cost of HDx was considered. However, when conservative savings from reduced hospitalization were factored in, the ICUR decreased to 10,422 US dollars. In a less conservative scenario with greater hospitalization rate reduction with HDx, no increase in ICUR was observed, and cost savings ensued, this being the dominant alternative.

Conclusions:

HDx enabled by Theranova is a cost-effective option, offering substantial economic benefit primarily through decreasing hospitalization rates and enhancing patient quality of life.

I have potential conflict of interest to disclose.
Dr Rivera and Dr Rutherford are employees of Baxter Healthcare Corporation. Dr Quitian is an employee of Faculty of Economics at University of Andes and has received honorarium for statistical analysis from Baxter Healthcare Corporation. Ms. Vesga and Ms. Aldana are employees of Renal Care Services Colombia, and Dr. Sanabria is an employee of Renal Care Services-Latin America.

I did not use generative AI and AI-assisted technologies in the writing process.