Abstract
Currently, the use of icodextrin solution and automated peritoneal dialysis (APD)
remains very expensive. This study aims to evaluate the feasibility of providing PD treatment
with icodextrin solution (CAPD with icodextrin) and nighttime intermittent PD (NIPD, APD during
night) for adult PD patients under the National Health Security System who suffer from fluid
and sodium overload. A cost-utility analysis (CUA) was conducted to compare these two
treatment methods with CAPD using only glucose-based solutions in PD patients.
Research Methodology: The study employed a stratified block randomization design, dividing
patients into 3 groups: CAPD, CAPD with icodextrin, and APD. Clinical outcomes were studied
and utilized for CUA. The sample size was calculated using KDQOL-36 quality of life data from
previous studies, resulting in 60 patients per group, totaling 180 patients from 16 hospitals
nationwide. Each hospital enrolled 12 patients, 4 per group. Patients were monitored every
two months for blood pressure, electrolyte levels, hemoglobin, lipid levels, dialysis adequacy,
solute removal via PD, survival rates, peritonitis incidence, peritoneal membrane changes, the
number and types of medications used, and quality of life using EQ-5D-5L and KDQOL-36
(Thai) tools. Markov model was use to evaluate cost-utility. Variables used in the model
included clinical variables and transitional probabilities derived from data collected in the 16
hospitals. Direct medical cost data were obtained from hospital databases, while utility and
non-medical direct cost data were gathered through patient interviews. Utility values were
measured using the EQ-5D-5L tool. The CUA was conducted from both governmental and
societal perspectives, with a lifetime study horizon and a 3% discount rate.
Results: From the governmental perspective, the lifetime costs of CAPD with icodextrin, APD,
and CAPD were 2,636,565, 2,008,802, and 1,804,929 THB, respectively, with quality-adjusted
life years (QALYs) of 3.80, 2.54, and 2.76, respectively. From a societal perspective, the lifetime
costs of CAPD with icodextrin, APD, and CAPD were 3,429,977, 2,623,402, and 2,487,161 THB,
with QALYs of 3.80, 2.54, and 2.76, respectively. In both governmental and societal
perspectives, compared to CAPD, the incremental cost-effectiveness ratio (ICER) of CAPD with
icodextrin was 801,315 THB per additional QALY and 908,440 THB per additional QALY from a
societal perspective. The ICER for APD was negative, as it resulted in increased costs with fewer
QALYs. Additionally, considering Thailand’s cost-effectiveness threshold of 160,000 THB per
additional QALY, CAPD had a 90% probability of being the most cost-effective option from a
societal perspective. These findings will serve as important data for shaping treatment
guidelines for end-stage renal disease patients undergoing peritoneal dialysis, in line with
societal affordability.
