Abstract
End stage renal disease (ESRD) has been a widespread disease in many countries, especially in Taiwan. According to statistics from the Taiwan Society of Nephrology in 2002, Taiwan ranks second globally in the prevalence and also has the highest incidence of ESRD. In addition, although ESRD patients occupy only 0.15% in the whole health insurance in Taiwan, it costs 7.2% (the highest of whole diseases) of the expense of health insurance. In other words, it is known that the resources and money spent in this disease become a huge burden in the society. Hence, this paper examined the cost-effectiveness of ESRD treatment for patients to make them treated with better cost-effectiveness treatment modalities. The Markov-chain model was used to study the influence of substitutive policies on the overall cost-effectiveness of the ESRD treatment program. After analyzing the cost-effectiveness of the treatments, a mathematical model was constructed to allocate the patients to maximize the effectiveness under the limited funds and to achieve their best QALYs (quality-adjusted life-years). The result shows that Peritoneal Dialysis is the treatment with better cost-effectiveness; therefore, various policies in the budget allocation model are constructed to analyze how the policy will change under different parameters by using sensitivity analysis. The method provides the government a reference for promoting popularization program to change patient proportions in the specific treatment.