Background: To optimize the allocation of health care expenditures, a systematic approach to economic evaluation of health interventions in Australia is required. The Assessing Cost-Effectiveness in Prevention Project (ACE-Prevention) is a project to assess the cost-effectiveness of 100 non-communicable preventive interventions, benchmarked against 50 existing non-preventive interventions. This Thesis examines the cost-effectiveness of renal replacement therapy for the Australian population with end-stage renal failure as one of the ACE-Prevention benchmarks.
Method: Three incremental cost-effectiveness ratios (ICERs) are assessed: (i) current program (moving patients from dialysis to transplantation when organs become available) compared to no treatment; (ii) renal dialysis compared to no treatment; and (iii) current program compared to renal dialysis. A modelled evaluation is done from a healthcare perspective, using a continuous-time, discrete-event microsimulation model. Epidemiological input data are largely from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), economic input data are based on the Victorian Maintenance Renal Dialysis Program. Uncertainty and sensitivity analyses were conducted to test the robustness of the outcomes.
Results: The incremental cost-effectiveness ratio (ICER) for the current program, moving patients from dialysis to transplantation when organs become available, is AU$67,000 ($65,000 - $68,000) when compared to no treatment and dominant when compared to a dialysis only intervention. Dialysis only compared to no treatment gives an ICER ofAU$104,000 ($103,000 - $ 105,000). If the ACE-Prevention threshold of$50,000 per disability-adjusted life year is adopted, then the current program is considered to be not cost-effective when compared to no treatment, but cost-saving when compared to dialysis only intervention.
Conclusion: Using a $50,000 per disability-adjusted life year willingness to pay threshold, the current program is not cost-effective. Arguably, in the case of renal replacement therapy, the 'rule of rescue' can be invoked to justify providing this rather expensive but life-saving treatment. This illustrates that results of economic evaluations are only one of several, rather than the sole determining mechanism, for ordering priorities of health interventions.