Economic evaluation of automated peritoneal dialysis among pediatric patients with end state kidney diseases in Thailand

Currently, due to the absence of economic evaluation information, automated peritoneal dialysis (APD) is not included in Thailand's Universal Health Coverage (UHC) benefit package. Therefore, we aimed to assess the cost-utility and budget impact of APD and continuous ambulatory peritoneal dialysis (CAPD) in pediatric end-stage kidney disease (ESKD) patients. A Markov model was applied to compare lifetime costs and health outcomes based on a social perspective using cost, utility, and transitional probability data from literature reviews. The results were presented as the incremental cost-effectiveness ratio (ICER). Moreover, one-way and probabilistic sensitivity analyses were performed to evaluate the uncertainty of all parameters. From a social perspective, patients receiving APD had higher total lifetime cost (14,791,473 baht) than those receiving CAPD (13,380,356 baht), but fewer life years (APD = 18.39, CAPD = 18.44) and higher quality adjusted life years (QALY) (APD = 16.31 and CAPD 15.65). At the societal willingness to pay in Thailand equal to 160,000 baht per QALY gained, APD would not be cost-effective (ICER = 3,063,598 baht per QALY gained). The inclusion of APD can result in an increase in annual budget of 54 million baht. Therefore, this study would help inform policy decisions regarding the inclusion of APD for pediatric with ESKD in the UHC benefit package.