To reuse or not to reuse? An economic evaluation of hemodialyzer reuse versus conventional single-use hemodialysis for chronic hemodialysis patients.
OBJECTIVE
To evaluate the cost-effectiveness of reusing hemodialyzers for patients with kidney failure on dialysis employing either a heated citric acid or formaldehyde sterilization method, in comparison to the standard practice of single-use dialysis.


METHODS
A meta-analysis of all relevant studies was performed to determine whether hemodialyzer reuse was associated with an increased relative risk of mortality or hospitalization. A decision tree was constructed to model the effect of three different dialysis strategies (single-use dialysis, heated citric acid, and formaldehyde dialyzer reuse) on the costs and quality-adjusted life expectancy of "typical" hemodialysis patients. The cost of heated citric acid reuse was estimated from a center experienced with the technique. The cost of end-stage renal disease (ESRD) care, survival data, and patient utilities were estimated from published sources.


RESULTS
There was evidence of a higher relative risk of hospitalization (but not mortality) for hemodialyzer reuse compared with single-use dialysis. Depending on the assumptions used, the cost savings that could be expected by switching from single-use dialysis to heated citric acid reuse were small, ranging from CAN $0-739 per patient per year.


CONCLUSIONS
ESRD programs can incorporate the results of this study based on their individual situations to determine whether hemodialyzer reuse is appropriate in their setting.
Manns
Braden J
BJ
University of Calgary.
Taub
Ken
K
Richardson
Robert M A
RM
Donaldson
Cam
C
D002170:Canada / Q000453:epidemiology; D019343:Citric Acid; D003661:Decision Support Techniques; D017743:Equipment Reuse / Q000191:economics*; D005260:Female; D005557:Formaldehyde; D017048:Health Care Costs; D015276:Health Care Rationing; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008297:Male; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics / Q000295:instrumentation*; D012307:Risk Factors; D013242:Sterilization / Q000379:methods; D013673:Technology Assessment, Biomedical
D005557:Formaldehyde; D019343:Citric Acid