Quality of Life among End-stage Renal Disease Treatments and Economic Evaluation of Renal Transplantation and Hemodialysis Treatments

Kyung-Ock Jeon; Sun-Young Son; Myung-Il Hahm; Soon-Il Kim

doi:10.4285/jkstn.2015.29.4.200

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Jeon, Son, Hahm, and Kim: Quality of Life among End-stage Renal Disease Treatments and Economic Evaluation of Renal Transplantation and Hemodialysis Treatments

Original Article

J Korean Soc Transplant 2015;29(4):200-208.

Published online: 10 December 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.4.200

Quality of Life among End-stage Renal Disease Treatments and Economic Evaluation of Renal Transplantation and Hemodialysis Treatments

Kyung-Ock Jeon, R.N.¹, Sun-Young Son, R.N.², Myung-Il Hahm, Ph.D.³, Soon-Il Kim, M.D.⁴

¹Organ Transplant Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

²Transplant Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

³Seoul, Department of Healthcare Management, Soonchunhyang University College of Medical Science, Seoul, Korea

⁴Asan, Department of Surgery and the Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea

Corresponding authors: Soon-Il Kim Department of Surgery and the Research Institute for Transplantation, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-2118, Fax: 82-2-313-8289 E-mail: soonkim@yuhs.ac

Myung-Il Hahm Department of Healthcare Management, Soonchunhyang University College of Medical Science, 22 Soonchunhyang-ro, Asan 31538, Korea Tel: 82-41-530-3035, Fax: 82-41-530-3085 E-mail: hmi@sch.ac.kr

Received 28 July 2015 Revised 2 October 2015 Accepted 26 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although renal transplantation is known as the best treatment for patients with end-stage renal disease, there are few of literature to identify economic evaluation of renal replacement therapies in Korea. This study was conducted to determine the cost-effectiveness of renal replacement treatments, particularly renal transplantation and hemodialysis.

Methods

We used the quality adjusted life year (QALY) calculated from survey data, which was collected from 124 patients who underwent kidney transplantation and 90 patients who were receiving hemodialysis. Medical costs were collected from five hospitals in Korea. The ERA-EDTA registry data (European Renal Association-European Dialysis and Transplant Association) were used for transition probability. A Markov model was used for predicting the cost-utility of transplantation and hemodialysis over the 10-year period.

Results

Renal transplantation offers lower cost and better outcome compared to hemodialysis. QALY per year of transplantation patients is higher than that of hemodialysis patients (transplantation 0.9465 vs. hemodialysis 0.8297). Cost per QALY gained is 15,566,000 won in transplantation patients whereas 32,765,000 won per QALY gained in hemodialysis patients was required.

Conclusions

Although cost of first year after transplantation was expensive, over 2 years, transplantation was more effective and less costly than hemodialysis. The results suggest that transplantation is more cost-effective than hemodialysis in Korea.

Keywords: Cost-benefit analysis, Kidney transplantation, Hemodialysis, Chronic kidney failure

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Table 1.

General characteristics of study subjects to measure the quality adjusted life year

Characteristic	Transplantation	Dialysis	P-value
Total	124 (57.9)	90 (42.1)
Sex
Female	57 (46.0)	53 (58.9)	0.084
Male	67 (54.0)	37 (41.1)
Age (yr)
20∼29	6 (4.8)	6 (6.7)	0.321
30∼39	12 (9.7)	14 (15.5)
40∼49	29 (23.4)	26 (28.9)
50∼59	48 (38.7)	24 (26.7)
60∼69	29 (23.4)	20 (22.2)
Continuous ^a	51.1±10.3	49±12.3	0.174
Income (thousand won)
＜1,000	8 (7.3)	29 (34.1)	＜0.001
1,000≤&＜2,000	21 (19.3)	14 (16.5)
2,000≤&＜3,000	29 (26.6)	16 (18.8)
3,000≤&＜5,000	37 (33.9)	19 (22.4)
5,000≤	14 (12.9)	7 (8.2)
Education (yr)
＜9	3 (2.4)	6 (6.9)	0.075
9≤&＜12	11 (8.9)	7 (8.0)
12≤&＜14	51 (41.1)	46 (52.9)
14≤	59 (47.6)	28 (32.2)
Job
Unemployed	3 (2.8)	3 (4.1)	0.411
Housewives	24 (22.2)	22 (29.7)
Non-manual	51 (47.2)	26 (35.1)
Manual	30 (27.8)	23 (31.1)
Universal health coverage
Health insurance	107 (90.7)	71 (80.7)	0.062
Medical aid	11 (9.3)	17 (19.3)
Private insurance
Yes	15 (12.4)	21 (23.9)	0.048
No	106 (87.6)	67 (76.1)
Region
Metropolitan	65 (52.4)	59 (65.6)	0.066
Urban	52 (41.9)	30 (33.3)
Rural	7 (5.7)	1 (1.1)

Data are presented as number (%) or mean±SD.

^a Continuous value of age.

Table 2.

Self-evaluated health status and QALY of respondents with EQ-5D among ESRD patients

Variable	Total	Transplantation	Dialysis	P-value
Total	214	124 (57.9)	90 (42.1)
Mobility				0.004
Level 1. No problem	178	111 (89.5)	67 (74.4)
Level 2. Some problem	32	13 (10.4)	19 (21.1)
Level 3. Severe problem	4	0	4 (4.5)
Self care				0.329
Level 1. No problem	202	119 (96.8)	83 (92.2)
Level 2. Some problem	6	2 (1.6)	4 (4.5)
Level 3. Severe problem	5	2 (1.6)	3 (3.3)
Usual activities				＜0.001
Level 1. No problem	152	106 (85.5)	46 (51.1)
Level 2. Some problem	59	18 (14.5)	41 (45.6)
Level 3. Severe problem	3	0	3 (3.3)
Pain/discomfort				＜0.001
Level 1. No problem	143	100 (80.6)	43 (47.8)
Level 2. Some problem	63	23 (18.6)	40 (44.4)
Level 3. Severe problem	8	1 (0.8)	7 (7.8)
Anxiety/depression				0.005
Level 1. No problem	151	98 (79.0)	53 (58.9)
Level 2. Some problem	59	25 (20.2)	34 (37.8)
Level 3. Severe problem	4	1 (0.8)	3 (3.3)
QALY per year	214	0.9465±0.0879	0.8297±0.2214	＜0.001
EQ-VAS	214	78.9±13.7	68.0±21.0	＜0.001

Data are presented as number (%) or mean±SD.

Abbreviations: QALY, quality adjusted life year; EQ-5D, EuroQ0l–5 dimension; ESRD, end-stage renal disease; EQ-VAS, EuroQol-visual analogue scale.

Table 3.

The cost-effectiveness of transplantation and hemodialysis in ESRD patients (unit 1,000 won)

Strategy	Cost	Incremental cost	Effectiveness (QALY)	Incremental effectiveness (QALY)	C/E	ICER (1,000 won/QALY)
Transplantation	97,053	–	6.23	–	15,566/1 QALY	Dominant (less costly
						& more effective)
Dialysis	133,447	36,394	4.07	−2.16	32,765/1 QALY	–

Abbreviations: ESRD, end-stage renal disease; QALY, quality adjusted life year; C/E, cost effectiveness ratio; ICER, incremental cost effectiveness ratio.

Table 4.

Results of sensitivity analysis by discount rate (unit 1,000 won)

Discount rate (%)	Strategy	Cost	Incremental cost	Effectiveness (QALY)	Incremental effectiveness (QALY)	C/E	ICER (1,000 won/QALY)
3	Transplantation	102,073	–	6.77	–	15,080	Dominant (less costly and more effective)
	Dialysis	142,706	40,633	4.37	−2.40	32,658
5	Transplantation	97,053	–	6.23	–	15,566	Dominant (less costly and more effective)
	Dialysis	133,447	36,394	4.07	−2.16	32,765
7	Transplantation	92,637	–	5.77	–	16,056	Dominant (less costly and more effective)
	Dialysis	125,304	32,667	3.81	−1.96	32,871

Abbreviations: QALY, quality adjusted life year; C/E, cost effectiveness ratio; ICER, incremental cost effectiveness ratio.

Table 5.

Results of sensitivity analysis by operation cost (unit 1,000 won)

Operation cost	Strategy	Cost	Incremental cost	Effectiveness (QALY)	Incremental effectiveness (QALY)	C/E	Incremental C/E (ICER)
10,035	Transplantation	92,033	–	6.23	–	14,761	Dominant (less costly and more effective)
	Dialysis	133,447	41,414	4.07	−2.16	32,765
20,070	Transplantation	97,053	–	6.23	–	15,566	Dominant (less costly and more effective)
	Dialysis	133,447	36,394	4.07	−2.16	32,765
30,105	Transplantation	102,073	–	6.23	–	20,456	Dominant (less costly and more effective)
	Dialysis	133,447	31,374	4.07	−2.16	32,765

Abbreviations: QALY, quality adjusted life year; C/E, cost effectiveness ratio; ICER, incremental cost effectiveness ratio.

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