Cost-effectiveness of a home-based educational programme on renal replace¬ment therapies: A proof-of-principle study

S. Redeker, M. Oppe, J.J. van Busschbach, W. Weimar, E.K. Massey, S.Y. Ismail

Thursday 14 march 2019

13:47 - 13:49h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

Background: Living donor kidney transplantation (LDKT) is the optimal treatment for most patients with end-stage renal failure (ESRD). Unfortunately, a significant number of these patients cannot find a living donor kidney. Previous research showed that our home-based programme increases knowledge on renal replacement therapies, increases discussing this knowledge with the social network of the patients, and increases LDKT. In this pilot study effects and costs of this intervention are evaluated and compared to the baseline in a state-transition model: A proof-of-principle study.

Methods: The parameters used in the model are the intervention effects, transition probabilities, incidence rates, health-stage related costs and quality adjusted life years (QALYs). Costs and QALY-data were obtained from the literature. Costs of the educational programme at the out-patient transplantation clinic of the Erasmus Medical Center were estimated. Transition probabilities and incidence rates were estimated from the database of all ESRD-patients in the Netherlands from 1990-2007.

Results: The pilot data suggests that the home-based educational programme offers both better effects and lower costs for ESRD patients compared to standard care from the second year onwards: an incremental cost-effectiveness ratio (ICER) of -€27.163 after year 2, indicating that after two years €27.163 is saved for every QALY gained. After ten years the ICER is €-29.906.

Conclusions: This proof-of-principle study demonstrates that the home-based education programme is dominant in terms of cost-effectiveness compared to standard care; after two years there is a gain in overall health with lower costs. However, the data used in the model is outdated and more recent parameters are warranted. The programme is now nationally implemented to evaluate the cost-effectiveness. Based on this proof-of-principle pilot, cost-effectiveness will be assessed using programme effects, programme costs and QALYs of the national implementation project across centers. Incidence rates and transition probabilities also have to be calculated with the most recent data to make a comprehensive cost-effectiveness analysis.