Background
End-stage renal disease (ESRD) is the end-stage of chronic renal insufficiency. It is characterized by permanent kidney damage. The only two treatments for ESRD are renal dialysis and kidney transplantation.
There are two common types of dialysis. Hemodialysis uses an extracorporeal circuit and a membrane to filter and clean the blood. Peritoneal dialysis uses the body's own peritoneal cavity to transfer solutes and toxins between the blood and the peritoneal dialysis fluid. Without a kidney transplant the patient must remain dialysis for life.
An ESRD patient can receive a transplant from a living donor whose kidney is a close match to that of the patient (living donor transplant). Alternatively, the patient can sign up for the kidney transplant waiting list and wait until a matching organ becomes available from a deceased individual (deceased donor transplant).
After a successful transplant, the patient regains normal renal functioning and no longer needs dialysis, although he/she will need immunosuppressive medications for the remainder of his/her life to prevent organ rejection. If the transplant failed but the patient survived, he/she would need dialysis.
Main data source
The data that you will need can be found in the United States Renal Data System 2015 Annual Data Report Volume I contains data summaries. Volume II and Reference Tables contain actual data.
Questions
Evaluate the cost-effectiveness of two treatment modalities for ESRD, namely, hemodialysis and deceased donor kidney transplantation.
1. Build a model for this analysis.
Assume that once a patient made a choice regarding treatment modality, he/she will not change his/her mind. In other words, once a patient chose dialysis, he/ she would not later choose transplant; and vice versa.
Because the number of patients who had a second transplant after the first transplant failed is very small, assume that an individual can receive only one transplant.
Because hemodialysis is the dominating form of dialysis, assume that when transplant fails and the patient returns to dialysis, he/she will receive hemodialysis.
The appropriate model may be a simple tree, a Markov model or the combination of both. Do what you see fit.
State any assumptions that you made if applicable.
2. Assume that the target population includes ESRD patients 50 to 59 years of age.
Mark all the probabilities with denotations (p1, p2, etc.) in your model. Provide the definition of each probability. Obtain the value of each probability and indicate where you found it.
State any assumptions that you made if applicable.
3. What do you think is an appropriate measure for effectiveness? Justify your answer.
4. Which of the two modalities results in longer life expectancy?
Show the steps of your calculations.
State any assumptions that you made if applicable.
5. What was the total monetary value of productivity loss due to hospitalization of all ESRD patients in 2015, in 2015 dollars?
6. What is the total cost of the ESRD program to Medicare from 2010 to 2013 in 2016 dollars?
State any assumptions that you made if applicable.
7. For a patient in the 50 - 59 age category, calculate the total cost of the two treatment options. Apply discounting. Which treatment option costs more?
8. Continuing from Question 7, conduct a sensitivity analysis on the total cost of transplant and dialysis by varying the probability of a successful transplant from 75 % to 95%.
Show the steps of your calculations and show your result graphically.
Was your conclusion in Question 7 sensitive to the uncertainty in the probability of a successful transplant?