title: Cost-effectiveness analysis of renal replacement therapy in Austria.
abstract: BACKGROUND
  Providing renal replacement therapy (RRT) for end-stage renal disease patients is resource intensive. Despite growing financial pressure in health care systems worldwide, cost-effectiveness studies of RRT modalities are scarce.
  
  
  METHODS
  We developed a Markov model of costs, quality of life and survival to compare three different assignment strategies to chronic RRT in Europe.
  
  
  RESULTS
  Mean annual treatment costs for haemodialysis were €43,600 during the first 12 months, €40,000 between 13 and 24 months and €40,600 beyond 25 months after initiation of treatment. Mean annual treatment costs for peritoneal dialysis were €25,900 during the first 12 months, €15,300 between 13 and 24 months and €20,500 beyond 25 months. Mean annual therapy costs for a kidney transplantation during the first 12 months were €50,900 from a living donor, €51,000 from a deceased donor, €17,200 between 13 and 24 months and €12,900 beyond 25 months after engraftment. Over the next 10 years in Austria with a population of 8 million people, increased assignment to peritoneal dialysis of 20% incident patients saved €26 million with a discount rate of 3% and gained 839 quality-adjusted life years (QALYs); additionally, increasing renal transplants to 10% from live donations saved €38 million discounted and gained 2242 QALYs.
  
  
  CONCLUSIONS
  Live donor renal transplantation is cost effective and associated with increase in QALYs. Therefore, preemptive live kidney transplantation should be promoted from a fiscal as well as medical point of view.
authors.affiliation: Department of Nephrology, Elisabethinen Hospital, Linz, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Haller
authors.forename: Georg
authors.initials: G
authors.lastname: Gutjahr
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Franz
authors.initials: F
authors.lastname: Harnoncourt
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
mesh_terms: D001317:Austria; D003362:Cost-Benefit Analysis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D019520:Living Donors; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D017582:Renal Replacement Therapy / Q000191:economics* / Q000401:mortality*; D012680:Sensitivity and Specificity; D015996:Survival Rate