Cost-Utility Analysis of Erythropoietin for Anemia Treatment in Thai End-Stage Renal Disease Patients with Hemodialysis.

Objective: To compare the cost utility of using erythropoietin (EPO) to maintain different hemoglobin (Hb) target levels in hemodialysis patients from a societal perspective.

Methods: A Markov model was used to estimate the incremental cost and quality-adjusted life-year of five Hb levels: 9 or less, more than 9 to 10, more than 10 to 11, more than 11 to 12, and more than 12 g/dl. A systematic review of EPO treatment in hemodialysis patients was conducted to estimate transitional probabilities. Cost data were estimated on the basis of the reference price of Siriraj Hospital, the largest university hospital in Thailand. Utility scores were derived from the six-dimensional health state short form (derived from short-form 36 health survey), which were collected from 152 hemodialysis patients receiving EPO at Siriraj hospital. Probabilistic sensitivity analysis was conducted to investigate the effect of uncertain parameters. All future costs and outcomes were discounted at the rate of 3% per annum.

Results: The incremental cost-effectiveness ratios of Hb levels more than 9 to 10, more than 10 to 11, more than 11 to 12, and more than 12 g/dl compared with the least costly option (Hb ≤ 9 g/dl) were US $24,128.03, US $18,789.07, US $22,427.36, and US $28,022.33 per quality-adjusted life-year, respectively. From probabilistic sensitivity analysis, the hemoglobin level of more than 10 to 11 g/dl was appropriate when the willingness to pay was US $15,523.88 to US $46,610.17 and the probability of cost-effective was 29.32% to 95.94%.

Conclusions: Providing EPO for a hemoglobin level of more than 10 to 11 g/dl had a cost-effectiveness higher than that of doing so for other hemoglobin levels. This finding will be put forward to the policy level to set up the EPO treatment guideline of the hospital for hemodialysis patients.