Dialysis for end-stage renal disease. Determining a cost-effective approach.
OBJECTIVE
Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many areas of uncertainty about which method of RRT should be chosen. This paper reports an economic model based on a systematic review that attempts to determine which method of dialysis, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis, a patient should have as the initial method of RRT.


METHODS
A systematic review and a costing exercise carried out in a Scottish hospital were used to populate a Markov model. Scenario analysis was used to model plausible variations in variables included in the model.


RESULTS
In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable variability, ranging from between 5,000 Pounds to 51,000 Pounds. The higher costs per life-year were associated with minimum estimates of additional survival for a patient starting RRT on hospital hemodialysis.


CONCLUSIONS
It may be more cost-effective to manage patients starting on RRT with hospital hemodialysis than CAPD. This has particular implications for the United Kingdom, given that up to 50% of new patients receive CAPD.
Kirby
L
L
University of Aberdeen.
Vale
L
L
D003362:Cost-Benefit Analysis / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D008390:Markov Chains; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics*; D006435:Renal Dialysis / Q000191:economics*; D012606:Scotland; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000379:methods