title: Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients.
abstract: BACKGROUND
  Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD).
  
  
  METHODS
  An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged >or=70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean euro/patient (patient-year).
  
  
  RESULTS
  The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 euro/patient in the first, 6500 euro/patient in the second and 682 euro/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in a worst-case hypothesis.
  
  
  CONCLUSIONS
  The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.
authors.affiliation: Center for Health Technology Assessment and Outcomes Research, University of Milan, Milan, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Scalone
authors.forename: Francesca
authors.initials: F
authors.lastname: Borghetti
authors.forename: Giuliano
authors.initials: G
authors.lastname: Brunori
authors.forename: Battista Fabio
authors.initials: BF
authors.lastname: Viola
authors.forename: Barbara
authors.initials: B
authors.lastname: Brancati
authors.forename: Laura
authors.initials: L
authors.lastname: Sottini
authors.forename: Lorenzo Giovanni
authors.initials: LG
authors.lastname: Mantovani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018753:Diet, Protein-Restricted / Q000191:economics*; D005260:Female; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000191:economics* / Q000628:therapy*; D008297:Male; D009313:National Health Programs; D006435:Renal Dialysis / Q000191:economics*; D012720:Severity of Illness Index; D016896:Treatment Outcome