Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Jun 22, 2024)
Date Submitted: Jun 19, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Home Care Program with Telemonitoring for Patients Undergoing Peritoneal Dialysis in South Korea: A Cost-Utility Analysis
ABSTRACT
Background:
The COVID-19 pandemic spurred the rapid adoption of a wide array of digital health technologies. To improve the quality of life by enhancing access to care, the Ministry of Health and Welfare of Korea has initiated a home care program that includes face-to-face educational consultation and remote patient monitoring. This new home care program should be evaluated to verify its long-term economic effectiveness.
Objective:
To examine the effectiveness of a digital health-based home care program, study investigated its cost-effectiveness by conducting a cost-utility analysis of a home care program for patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) in a tertiary care hospital.
Methods:
The study constructed a Markov model to evaluate the lifetime cost-effectiveness of the PD home care program. Cohorts of 1,000 patients aged 50 years with a PD health state were simulated to make a state transition at one-year cycles. The effectiveness variable was measured as quality-adjusted life years (QALYs), and a cost-utility analysis was conducted with a limited societal perspective. The willingness-to-pay (WTP) threshold was set to KRW 40,043,036 (GDP per capita) per increasing 1 QALY, and the discount rate of 4.5% was applied for both QALYs and costs. A half-cycle correction was reflected, and the main outcomes were the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit. Scenario, sensitivity, and expected value of perfect information (EVPI) analyses were performed to reflect the uncertainty.
Results:
In the base case analysis, the ICER was calculated as KRW 4,571,500 per QALY. Regardless of the scenarios, the results of the base case analyses were in the range of the WTP threshold. A one-way sensitivity analysis was performed, and the most sensitive parameters were the costs of PD (home care) and PD (usual care) in every scenario. For the outcome of the Monte Carlo simulation (10,000 iterations), the home care group represented an optimal overall strategy, with probabilities of 62.05% in Scenario 1, 59.95% in Scenario 2, 61.70% in Scenario 3, and 89.41% in Scenario 4. The WTP threshold where the probabilities of the home care group were optimal at above 50% was KRW 7,380,000. Finally, EVPI was measured and showed an additional KRW 14,818,960 per patient gained when all parameter information was obtained without uncertainty.
Conclusions:
This study evaluated the cost-effectiveness of a novel home care program for patients undergoing PD in Korea and demonstrated that the ICER was under the WTP threshold. Therefore, implementing a home care program for these patients may be cost-effective. Clinical Trial: N/A
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