title: The STARRT trial: a cost comparison of optimal vs sub-optimal initiation of dialysis in Canada.
abstract: BACKGROUND
  Sub-optimal transitioning of patients from chronic kidney disease (CKD) to end stage renal disease (ESRD) may result in poor clinical outcomes and increased healthcare costs. The objectives of this study were to estimate the average total cost per patient who requires initiation of renal replacement therapy (RRT) stratified by status at initiation; optimal (RRT initiation as an outpatient with an arterio-venous [AV] Fistula, Graft or Peritoneal Dialysis [PD] catheter), and sub-optimal (RRT initiation as an inpatient and/or via central venous catheter [CVC]).
  
  
  METHODS
  Data from the Study To Assess Renal Replacement Therapy (STARRT), a Canadian, multi-centre, 6 month retrolective study (n = 339), were used for this analysis. Unit costs for resources were obtained from participating hospitals, the literature, and/or standard costing sources. The analysis was performed from the perspective of healthcare payors and reported in 2011 Canadian Dollars (CAD). A propensity score technique was applied to control for potential confounders between the two groups.
  
  
  RESULTS
  Two hundred of the eligible patients for analysis (61.9%) were sub-optimally and 123 (38.1%) were optimally prepared. For this analysis, 106 "matched" pairs were used. The average total cost per patient was estimated to be $63,225 (with a 95% CI ranging from $58,663-$67,958) for the sub-optimally initiated patients, and $39,260 (with a 95% CI ranging from $35,683-$43,007) for the optimally initiated patients (p < 0.001).
  
  
  CONCLUSIONS
  Costs were calculated utilizing a conservative approach, using the cheapest available prices for medications and other resources. Assumptions had to be made for the costing of dialyses.
  
  
  CONCLUSIONS
  The results of this study indicate, after adjusting for potential confounders, that optimally initiated patients for RRT have significantly lower healthcare-associated costs compared to sub-optimally initiated patients.
authors: PIVINA Consulting Inc., Mississauga, ON, Canada. cpiwko@pivina.com
authors: Charles
authors: C
authors: Piwko
authors: Colin
authors: C
authors: Vicente
authors: Lou
authors: L
authors: Marra
authors: Farah
authors: F
authors: Jivraj
authors: Eva
authors: E
authors: Appel
authors: Jacob
authors: J
authors: Wolpin
authors: Fernando
authors: F
authors: Camacho
authors: David C
authors: DC
authors: Mendelssohn
authors: Phil A
authors: PA
authors: McFarlane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods*; D055815:Young Adult