Cost-effectiveness analysis of haemodialysis and comprehensive conservative care in managing end-stage renal disease in Abuja, Nigeria

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Abstract
Background Managing end-stage renal disease (ESRD) is cost-intensive and unaffordable for most people in low and middle-income countries such as Nigeria. Nonetheless, the benefit package of health insurance schemes excludes chronic kidney disease in Nigeria. This study aimed to determine the cost-effectiveness of haemodialysis compared to comprehensive conservative care (CCC) in managing ESRD patients in Nigeria. Methods Using direct costs, we conducted a cost-utility analysis of haemodialysis versus CCC from the provider and patient perspectives. The effectiveness of the two alternatives was determined using Disability-Adjusted Life Years (DALYs) averted. We discounted DALYs at 3%, but not costs, because costs were cross-sectional data collected within a year. We used average and incremental cost-effectiveness ratios to compare the cost-effectiveness of the two alternatives. We used one-way sensitivity analysis to assess the robustness of the results. Results The unit costs of providing haemodialysis and CCC were $152.21 and $72.44, respectively. The discounted mean DALYs averted per person were $151.7 and $111.1 per DALY averted for haemodialysis and CCC patients, respectively. The average cost-effectiveness ratios were $1.00 and $0.65 per DALY averted for haemodialysis and CCC patients, respectively. Compared to CCC, the incremental cost-effectiveness ratio (ICER) of haemodialysis is $1.97 per DALY averted. Conclusion Haemodialysis is substantially more effective and highly cost-effective than CCC for managing ESRD in Nigeria. The findings endorse increasing the coverage of haemodialysis in Nigeria's universal health coverage schemes to make haemodialysis more accessible for ESRD patients needing sustainable kidney care.

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