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Economic Evaluation of the Ministry of Health Nephrology Services: Cost effectiveness of Centre Haemodialysis and Continuous Ambulatory Peritoneal Dialysis in the Ministry of Health hospitals

Economic Evaluation of the Ministry of Health Nephrology Services: Cost effectiveness of Centre Haemodialysis and Continuous Ambulatory Peritoneal Dialysis in the Ministry of Health hospitals

Nephro CEA study

General Information
Research Type
Clinical
Description
This is a multi-center observational study designed to determine the cost efficiency and cost-effectiveness of the HD and CAPD services of the MOH dialysis program.
Cost-efficiency will be measured by cost per unit output; outputs being number of HD treatment procedures or number of CAPD patient-months.
Cost-effectiveness will be measured by the Cost per life-year saved on HD or CAPD.

For the cost-efficiency component of the study, the unit of analysis is dialysis centre (both HD and CAPD). A total of 55 such MOH sites, comprising 44 HD centres and 11 CAPD centres, will be enrolled into this study. Each site shall collect data on their cost inputs in year 2001 as well as their outputs between 1997 and 2001 inclusive.

For the cost-effectiveness component of the study, the unit of analysis is individual patients on dialysis in the MOH program. 30 patients for each treatment to be evaluated from about 10 to 12 participating sites who meet inclusion/exclusion criteria will be enrolled into the study. The treatment alternatives to be compared are centre HD and CAPD, the target population for these interventions are patients with ESRF who were able to access MOH dialysis treatment between 1980 and 2001 inclusive.

The viewpoint taken for the cost-effectiveness evaluation will be that of MOH. Hence, only costs borne by MOH in providing dialysis care will be included, and costs borne by patients are excluded.

The outcome of interest is survival on dialysis. All other benefits of dialysis care whether to patients or indirectly to family members or society are excluded from consideration.
Thus, given the outcome measure, the time horizon for this study shall be the lifetime of dialysis patients in the MOH program. The event pathway shall encompass all significant medical events for a cohort of dialysis patients in the MOH program from inception of dialysis-to-dialysis termination for whatever reasons (death, transplantation, etc).
Subjects who had commenced dialysis in the MOH program between 1980 and 2001 will be randomly sampled with probability proportional to number of patients in the dialysis unit. The NRR database will be used as sampling frame. Data on each sampled subject’s utilisation of resources (out-patient visits, hospitalisation, drugs, investigation) in the course of his/her life long care will be abstracted from medical record. All HD or CAPD related resource utilisation by a subject would be imputed based on average HD and CAPD production costs determined from the cost-efficiency component of the same study.
Study Information
RMK Priority Area
Research Level
Research Keyword
Economic evaluation, cost effectiveness, cost efficiency, end-stage renal failure, haemodialysis, continuous ambulatory peritoneal dialysis
Inclusion & Exclusion Criteria
Inclusion Criteria
The study population consists of:
For the cost-efficiency component of the study, all MOH dialysis providers, comprising 44 HD centres and 11 CAPD centres, will be enrolled into this study

For the cost-effectiveness component of the study, all subjects must satisfy the following inclusion criteria:
1. Has ESRF and on dialysis (HD and/or CAPD) between 1980 and 2001 in the MOH program
2. Without missing medical records for at least three-quarter of the duration he/she was on dialysis
Exclusion Criteria
The study population consists of:
For the cost-efficiency component of the study, all MOH dialysis providers, comprising 44 HD centres and 11 CAPD centres, will be enrolled into this study

For the cost-effectiveness component of the study, all subjects must satisfy the following inclusion criteria:
1. Has ESRF and on dialysis (HD and/or CAPD) between 1980 and 2001 in the MOH program
2. Without missing medical records for at least three-quarter of the duration he/she was on dialysis
Study Timeline
Expected / Actual Date Study Starts - First Enrolment of subject / Collecting data
Oct, 01 2002
Expected / Actual Date Study Completed
Nov, 06 2003
Expected / Actual Duration of Study Enrollment / Data Collection
57 weeks