Work

Cost-utility analysis and budget impact of policy options for kidney replacement therapy coverage for end-stage kidney disease in Kenya

Year: 2026

Type: article

Abstract: Objectives To evaluate the cost-utility and budget impact of alternative kidney replacement therapy (KRT) modalities and policy options for patients with end-stage kidney disease (ESKD) in Kenya. Design Cost-utility and budget impact analyses were conducted using a decision-analytic Markov model. Deterministic one-way and probabilistic sensitivity analyses assessed parameter uncertainty. Model face validity was assessed through consultation with nephrology experts and external validation compared model-predicted survival among kidney transplant recipients with observed survival data. Budget impact was assessed over 5 years from the perspective of the Social Health Authority (SHA). Setting Kenya Participants Adults receiving KRT for ESKD. Interventions Three KRT modalities, that is, peritoneal dialysis (PD), haemodialysis (HD) and kidney transplantation (KT) were compared. Compared with current practice (scenario 1), four policy scenarios were initiating all incident ESKD patients on PD (scenario 2), expanding KT coverage to achieve an additional 10% coverage within 5 years (scenario 3), redistributing coverage to 68% HD, 20% PD and 12% KT (scenario 4), and providing HD three times per week to 20% of patients currently receiving HD two times per week (scenario 5). Primary and secondary outcome measures Primary outcomes were incremental cost-effectiveness ratio and incremental net monetary benefit. Secondary outcomes included costs, life years and quality-adjusted life years (QALYs) over 5-, 10-, 15-year and lifetime horizons. Results PD had the highest lifetime costs compared with HD and KT. At a willingness-to-pay threshold of 120 000 Kenya shillings per QALY gained, KT was dominant compared with PD over the lifetime horizon and compared with HD over 10-year and 15-year horizons. Scenario 3 was dominant over 5-, 10- and 15-year horizons and had the lowest 5-year budget impact. Conclusions Expanding access to KT appears economically efficient for improving ESKD coverage in Kenya, although decisions should consider uncertainty in key model parameters and health systems requirements for KT expansion.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-123693