title: Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan.
abstract: OBJECTIVE
  The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time.
  
  
  METHODS
  By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results.
  
  
  RESULTS
  Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years.
  
  
  CONCLUSIONS
  It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally.
  
  
  CONCLUSIONS
  Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.
authors.affiliation: Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan. shirakaba@clg.niigata-u.ac.jp
authors.forename: Utako
authors.initials: U
authors.lastname: Shimizu
authors.forename: Shota
authors.initials: S
authors.lastname: Saito
authors.forename: Yiwei
authors.initials: Y
authors.lastname: Lings
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iino
authors.forename: Junichirou James
authors.initials: JJ
authors.lastname: Kazama
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D017582:Renal Replacement Therapy / Q000191:economics* / Q000379:methods*; D012680:Sensitivity and Specificity