KyungYi Kim, Tae Hyun Kim, Jaeyong Shin, Suk-Yong Jang, Hyung Woo Kim, Beom Seok Kim, Sang Gyu Lee
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引用次数: 0
Abstract
Background: The COVID-19 pandemic accelerated the use of digital health technologies to improve care access and quality of life. The Korean Ministry of Health and Welfare introduced a home care program for end-stage renal disease patients on peritoneal dialysis (PD), incorporating educational consultations and remote monitoring. This study evaluates the long-term economic effectiveness of this digital health-based home care program.
Methods: A Markov model was developed to assess the lifetime cost-effectiveness of the PD home care program. Simulations involved 1,000 patients aged 50 in a PD health state, transitioning annually. Effectiveness was measured in quality-adjusted life years (QALYs), and a cost-utility analysis was performed from a limited societal perspective. The willingness-to-pay (WTP) threshold was US$ 32,255 (gross domestic product per capita) per QALY, with a 4.5% discount rate for both QALYs and costs. Outcomes included the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit, with scenario, sensitivity, and expected value of perfect information (EVPI) analyses addressing uncertainty.
Results: The base case analysis yielded an ICER of $4,895 per QALY, well within the WTP threshold. Sensitivity analysis highlighted PD-associated costs as the most critical parameters. Monte Carlo simulations (10,000 iterations) indicated a 79.0% probability of the home care program being optimal. EVPI analysis suggested an additional $2,963 per patient with perfect parameter information.
Conclusion: The PD home care program in Korea appears to be a cost-effective strategy, potentially reducing peritonitis incidence and enhancing healthcare efficiency.
期刊介绍：
Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.
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