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Hemodialysis for end-stage renal disease: A cost-effectiveness analysis of treatment options

Published online by Cambridge University Press:  02 March 2005

Juan G. Gonzalez-Perez ,
Luke Vale ,
Sally C. Stearns  and
Sarah Wordsworth
Juan G. Gonzalez-Perez
Affiliation:
University of Aberdeen
Luke Vale
Affiliation:
University of Aberdeen
Sally C. Stearns
Affiliation:
University of North Carolina at Chapel Hill
Sarah Wordsworth
Affiliation:
Univesity of Oxford
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Abstract

Background: During 2001, over 32,000 patients in the United Kingdom received renal replacement therapy (RRT). Approximately half had a functioning transplant, with the remainder receiving dialysis therapy. The main form of dialysis is hemodialysis (HD), which is provided to 37.1 percent of the RRT population. HD is provided in three main settings: hospital (24.5 percent), satellite (10.9 percent), or home (1.7 percent). The objective of this study is to explore the cost-effectiveness of these different modalities.

Methods: By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the three different modalities. The model included direct health service costs and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of the results.

Results: Satellite HD has lower costs £46,000 and £62,050 at 5 and 10 years than home HD £47,660 and £63,540. The total effectiveness of home HD was slightly greater than for satellite HD, so the incremental cost per QALY of home versus satellite HD was modest at £6,665 at 5 years and £3,943 at 10 years. Both modalities dominated hospital HD.

Conclusions: Results from the study reveal that satellite HD was less costly than home HD, and home HD was less costly than hospital HD. The lack of robust data on the effectiveness and new dialysis equipment, which were not included in this review, throws some caution on these results. Nonetheless, the results are supportive of a shift from hospital HD to satellite and home HD.

Keywords

Cost-benefit analysisQuality-adjusted life yearsHemodialysis homeRenal dialysisHealth service costs
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 1 , January 2005 , pp. 32 - 39
Copyright
© 2005 Cambridge University Press

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