Table 1 Methodological approach using the iDSI reference case
Principle | The analysis should … | Dialysis approach |
|---|---|---|
Transparency | Be clearly communicated | A ‘learn-by-doing’ approach was undertaken to ensure stakeholder engagement, learning, and translation of results |
Comparators | Reflect decision problem. ‘No comparator’ optional | The comparator was HD, to reflect the decision problem and local standard of care. ‘No comparator’ was excluded as it was not considered a reasonable policy option |
Evidence | Consider all available evidence | Dialysis was partially selected due to already available local cost data, and a recent systematic review on clinical effectiveness. Additional data needs were supplemented by rapid review and personal communication with co-authors |
Health outcomes | Be appropriate to decision problem, capture positive and negative effects on length and quality of life, and be generalizable across disease states | Quality-adjusted life years (QALYs) were selected given availability of evidence from other jurisdictions |
Costs | Reflect all differences in intervention and comparator costs | Costs reflect best available evidence on HD and PD, though limitations with PD data affect the certainty of results. No estimation of changes due to (diseconomies) of scale were made |
Time horizon | Be sufficient to capture all costs and effects | A lifetime horizon was used |
Non-health effects and costs outside the health budget | Be identified if relevant to the research question | The analysis’ focus was limited to the payer perspective, due to lack of locally available data to inform the optional societal perspective |
Heterogeneity | Explore sub-populations | Two age groups were explored – 15–49 and over 50 to reflect the young age of most patients undergoing dialysis in Rwanda |
Uncertainty | Be appropriately characterized | Deterministic and probabilistic sensitivity analysis were undertaken |
Constraints | Evaluation budget impact including infrastructural/ resource constraints | Budget impact analysis was undertaken and is available in Supplement 1. Infrastructural constraints were likely underestimated for PD due to limited data |
Equity considerations | Consider equity implications | Equity implications were considered only qualitatively |