Affiliation:
1. University of Nigeria Enugu Campus
2. Dalhousie University
Abstract
Abstract
Background
Managing end-stage renal disease (ESRD) is cost-intensive and unaffordable for most people in low and middle-income countries such as Nigeria. Nonetheless, the benefit package of health insurance schemes excludes chronic kidney disease in Nigeria. This study aimed to determine the cost-effectiveness of haemodialysis compared to comprehensive conservative care (CCC) in managing ESRD patients in Nigeria.
Methods
Using direct costs, we conducted a cost-utility analysis of haemodialysis versus CCC from the provider and patient perspectives. The effectiveness of the two alternatives was determined using Disability-Adjusted Life Years (DALYs) averted. We discounted DALYs at 3%, but not costs, because costs were cross-sectional data collected within a year. We used average and incremental cost-effectiveness ratios to compare the cost-effectiveness of the two alternatives. We used one-way sensitivity analysis to assess the robustness of the results.
Results
The unit costs of providing haemodialysis and CCC were $152.21 and $72.44, respectively. The discounted mean DALYs averted per person were $151.7 and $111.1 per DALY averted for haemodialysis and CCC patients, respectively. The average cost-effectiveness ratios were $1.00 and $0.65 per DALY averted for haemodialysis and CCC patients, respectively. Compared to CCC, the incremental cost-effectiveness ratio (ICER) of haemodialysis is $1.97 per DALY averted.
Conclusion
Haemodialysis is substantially more effective and highly cost-effective than CCC for managing ESRD in Nigeria. The findings endorse increasing the coverage of haemodialysis in Nigeria's universal health coverage schemes to make haemodialysis more accessible for ESRD patients needing sustainable kidney care.
Publisher
Research Square Platform LLC
Reference31 articles.
1. Cost Effectiveness of Dialysis Modalities: A Systematic Review of Economic Evaluations;Howell M;Appl Health Econ Health Policy,2019
2. Arogundade FA, Esezobor CI, Okafor HU, Abdu A, Balogun RA, Effa EE, Popoola J, Bamgboye EL. Nephrology in Nigeria. In: Divino-Filho JC, Moura-Neto JA, Ronco C, editors. Nephrology worldwide. Switzerland: Springer; 2021.
3. The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations;Yang F;Appl Health Econ Health Policy,2021
4. A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway;Busink E;Eur J Health Econ,2023
5. Filtering for the best policy: An economic evaluation of policy options for kidney replacement coverage in the Philippines;Bayani DBS;Nephrol (Carlton),2021