title: Cost-effectiveness of initiating dialysis early: a randomized controlled trial.
abstract: BACKGROUND
  Planned early initiation of dialysis therapy based on estimated kidney function does not influence mortality and major comorbid conditions, but amelioration of symptoms may improve quality of life and decrease costs.
  
  
  METHODS
  Patients with progressive chronic kidney disease and a Cockcroft-Gault estimated glomerular filtration rate of 10-15 mL/min/1.73 m(2) were randomly assigned to start dialysis therapy at a glomerular filtration rate of either 10-14 (early start) or 5-7 mL/min/1.73 m(2) (late start).
  
  
  METHODS
  Of the original 828 patients in the IDEAL (Initiation of Dialysis Early or Late) Trial in renal units in Australia and New Zealand, 642 agreed to participate in this cost-effectiveness study. STUDY PERSPECTIVE & TIMEFRAME: A societal perspective was taken for costs. Patients were enrolled between July 1, 2000, and November 14, 2008, and followed up until November 14, 2009.
  
  
  METHODS
  Planned earlier start of maintenance dialysis therapy.
  
  
  RESULTS
  Difference in quality of life and costs.
  
  
  RESULTS
  Median follow-up of patients (307 early start, 335 late start) was 4.15 years, with a 6-month difference in median duration of dialysis therapy. Mean direct dialysis costs were significantly higher in the early-start group ($10,777; 95% CI, $313 to $22,801). Total costs, including costs for resources used to manage adverse events, were higher in the early-start group ($18,715; 95% CI, -$3,162 to $43,021), although not statistically different. Adjusted for differences in baseline quality of life, the difference in quality-adjusted survival between groups over the time horizon of the trial was not statistically different (0.02 full health equivalent years; 95% CI, -0.09 to 0.14).
  
  
  CONCLUSIONS
  Missing quality-of-life questionnaires and skewed cost data, although similar in each group, decrease the precision of results.
  
  
  CONCLUSIONS
  Planned early initiation of dialysis therapy in patients with progressive chronic kidney disease has higher dialysis costs and is not associated with improved quality of life.
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Australia. anthony.harris@monash.edu
authors.forename: Anthony
authors.initials: A
authors.lastname: Harris
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.forename: Jing Jing
authors.initials: JJ
authors.lastname: Li
authors.forename: Liliana
authors.initials: L
authors.lastname: Bulfone
authors.forename: Pauline
authors.initials: P
authors.lastname: Branley
authors.forename: John F
authors.initials: JF
authors.lastname: Collins
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Fraenkel
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Joan
authors.initials: J
authors.lastname: Kesselhut
authors.forename: Grant
authors.initials: G
authors.lastname: Luxton
authors.forename: Andrew
authors.initials: A
authors.lastname: Pilmore
authors.forename: Martin
authors.initials: M
authors.lastname: Rosevear
authors.forename: David J
authors.initials: DJ
authors.lastname: Tiller
authors.forename: Carol A
authors.initials: CA
authors.lastname: Pollock
authors.forename: David C
authors.initials: DC
authors.lastname: Harris
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome