An Economic Evaluation of the Establishment of a Paediatric Dialysis Unit at Pietersburg Hospital, Polokwane, Limpopo

Abstract

Introduction: Many children who develop end stage kidney disease in South Africa are denied therapy due to their distance from the hospital. Decentralising paediatric nephrology services would go a long way to relieving the burden on these children and their families. Pietersburg Hospital, Polokwane, has the potential to house a paediatric satellite dialysis unit, but some understanding of the costs and benefits of such a program is needed before it is implemented. Methods: A cost utility analysis was performed using Markov modelling techniques to analyse the expected costs and benefits of such a program from both the societal and the healthcare payer perspectives. The cost effectiveness was evaluated by analysing incremental cost effectiveness ratios (ICER) and incremental net monetary benefits generated by the analysis. All cost data was obtained from a cohort of children receiving chronic kidney replacement therapy (dialysis and/or kidney transplant) at the Nelson Mandela Children’s Hospital (NMCH) between 1 April 2019 and 31 March 2022. The comparator was represented by data from children whose home address was more than 150 km from NMCH, and from a group of “Unstable Kidney Transplant” patients, while the intervention was the theoretical establishment of a satellite paediatric dialysis unit at Pietersburg Hospital, Polokwane, represented by data from children whose home address was less than 150 km from NMCH, and from a group of “Stable kidney transplant” patients. Results: The deterministic sensitivity analysis predicted that the intervention would be cost effective from both the societal and the healthcare payer perspectives and showed that length of stay resulted in the largest change in the ICER. The probabilistic sensitivity analysis also predicted that the intervention would be cost effective from both the societal and the healthcare payer perspectives. The cost effectiveness acceptability curves demonstrated that the intervention was likely to be cost effective more than 50% of the time for a willingness to pay threshold of ZAR 112 000 (or one times the average gross domestic product per capita for South Africa in 2022). Conclusion: Our findings are in conformity with data from the literature which show that satellite dialysis units can be cost effective. Establishing a satellite unit at Pietersburg Hospital, Polokwane for the treatment of children with end stage kidney disease in the area would not vi only improve access and quality of life for these children, but it is also likely to be cost effective, from both the societal and the healthcare payer perspectives. We hope that these findings will encourage the introduction of, at least, a pilot program at Pietersburg Hospital, Polokwane to establish the validity of our results. Success with this model could then be used as a template to roll out similar projects across the region.