ECONOMIC IMPACT OF HDX THERAPY ENABLED BY THERANOVA DIALYZER IN THE AUSTRALIAN SETTING.

Introduction:

Chronic kidney disease (CKD) is a complex, progressive and life-limiting disease, multifactorial in etiology and expensive to manage. Hemodialysis is the dominant modality of kidney replacement therapy (KRT) in Australia, accounting for 99.6% of the approximately 1.5 million hospitalizations for dialysis annually. However, unlike the superior filtration performance of HDx therapy enabled by Theranova dialyzer, the high-flux hemodialyzers in current use are inefficient at clearing large-middle molecules, the uremic products at least partially responsible for the high morbidity and mortality associated with dialysis. The objective was to evaluate the economic impact of adopting HDx therapy enabled by Theranova dialyzer in the Australian setting.

Methods:

A budget impact economic model developed by Baxter Healthcare was adapted using Australian epidemiological and cost data for hospitalization and resources used.2-8

Results:

The economic model showed that by progressively substituting HDx therapy enabled by Theranova dialyzer for high-flux dialyzers at a modest annual rate of 10%, aggregated budget savings of about A$500 million (discounted; approx. US$323m) would be achieved nationally over five years (Figure 3). The savings in the fifth year alone, by when 50% of patients would be treated with HDx therapy enabled by Theranova dialyzer, would be about A$164 million (discounted), corresponding to about 10% of the annual expenditure on hospital services for CKD. 

Figure 1. Incremental cost savings (undiscounted) potentially achieved in Australia by progressively replacing high-flux dialyzers with HDx therapy enabled by Theranova dialyzer at an annual rate of 10%. 

Table 1. Dialysis patient population in Australia

1. National KRTP population in 2021 [2].
2. Based on KRTP prevalence 2016-2021 [2].

Table 2. Proportions of hemodialysis patients treated with high-flux and HDx therapy enabled by Theranova dialyzer over the first five years of a dialyser-substitution program in Australia

1. Base year = national hemodialysis population in 2021 [2].

Table 3. Hemodialysis resources used in the Australian setting

1. Hospitalization rate (patient-year) [3].
2. Hospitalization incidence rate reduced by 45.1% with Theranova [1].
3. ESA = erythropoiesis stimulating agent.

Table 4. Hemodialysis resource costs in the Australian setting

1. Baxter Revaclear high-flux dialyzer list price (2022); assumed constant over 5-year time horizon.
2. Baxter Theranova dialyzer list price (2022); assumed constant over 5-year time horizon.
3. ESA = erythropoiesis stimulating agent; Epoetin lambda (Australian Pharmaceutical Benefits Scheme (PBS), code    9595B) [8].
4. Iron sucrose (PBS code 8807M) [8].

Figure 2. Budget impact of progressively substituting HDx therapy enabled by Theranova dialyzer  for high-flux dialyzers in Australia at 10% a year over five years: annual costs (undiscounted) compared

1.ESA = erythropoiesis stimulating agent.

Figure 3. Budget impact of progressively substituting HDx therapy enabled by Theranova dialyzer for high-flux dialyzers in Australia at 10% a year over five years: incremental and aggregated costs (discounted)1

1.Discount rate = 5%.
ESA = erythropoiesis stimulating agent.

Conclusions:

HDx therapy enabled by Theranova dialyzer is cost-saving overall in the Australian setting, and presents a practical opportunity to significantly reduce the economic impact of KRT without compromising the delivery of high-quality clinical care.

References

1.      Blackowicz MJ, Falzon L, Beck W, Tran H, Weiner DE. Economic evaluation of expanded hemodialysis with the Theranova 400 dialyzer: A post hoc evaluation of a randomized clinical trial in the United States. Hemodial Int. 2022 Jul;26(3):449-455.

2.      Australia and New Zealand Dialysis and Transplant Registry. ANZDATA 45th Annual Report, 2022. Adelaide, SA: ANZDATA, 15 Sept 2022. Available at: https://www.anzdata.org.au/report/anzdata-45th-annual-report-2022-data-to-2021/

3.      McDonald SP, Tong B. Morbidity burden of end-stage kidney disease in Australia: hospital separation rates among people receiving kidney replacement therapy. Nephrology (Carlton). 2011 Nov;16(8):758-66.

4.      Australia and New Zealand Dialysis and Transplant Registry. ANZDATA 44th Annual Report, 2021. Adelaide, SA: ANZDATA, 15 Sept 2021. Available at: https://www.anzdata.org.au/report/anzdata-44th-annual-report-2021-data-to-2020/

5.      DOPPS Practice Monitor – Hemodialysis. Ann Arbor, MI: DOPPS Coordinating Center. Available at: https://www.dopps.org/DPM-HD/

6.      United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2020.

7.      Independent Health and Aged Care Pricing Authority. National Hospital Cost Data Collection Report, Public sector, Round 24 (Financial year 2019-20). Appendix, AR-DRG Version 10, Table 7, Acute Product by Jurisdiction. Sydney: IHACPA, Oct 2021. Available at:
https://www.ihacpa.gov.au/sites/default/files/2022-08/NHCDC%20Round%2024%20Appendix.xlsm

8.      Australian Department of Health and Aged Care. Pharmaceutical Benefits Scheme:
Ex-manufacturer prices (excluding Efficient Funding of Chemotherapy) - 1 January 2023. Canberra: Department of Health and Aged Care, 1 Jan 2023. Available at: https://www.pbs.gov.au/industry/pricing/ex-manufacturer-price/2023/ex-manufacturer-prices-non-efc-2023-01-01.XLSX

I have no potential conflict of interest to disclose.

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