title: Five-year cost-utility analysis of acute renal replacement therapy: a societal perspective.
abstract: OBJECTIVE
  Assessment of the cost utility (CU) of acute renal replacement therapy (RRT) from a societal perspective during a 5-year follow-up.
  
  
  METHODS
  This was a cross-sectional cohort study in a medical-surgical intensive care unit and an acute RRT unit of 410 consecutive patients treated with acute RRT in Helsinki University Hospital in 2000-2002. Five-year survival and health-related quality of life (HRQoL) were assessed and used to calculate quality-adjusted life years (QALYs) in two ways. They were first calculated for the 5-year follow-up period and, second, estimated for the expected lifetime. HRQoL was assessed by the EuroQol (EQ-5D) in 2003. The cost analysis included hospital costs during index hospitalization along with hospital and societal costs for the following 5 years. The CU ratio was determined as total costs divided by gained QALYs.
  
  
  RESULTS
  Median survival time for all patients was 0.20 years and the EQ-5D index score was 0.68, 0.18 lower than that of the age- and gender-matched general population. All RRT-treated patients gained 0.10 QALYs/patient and hospital survivors 2.54 QALYs in 5 years. Overall the CU ratio was poor [5 year median 271,116 (29,782-2,177,581) €/QALY]. However, it was acceptable (less than 50,000 €/QALY) in patients who survived for more than a year and did not need chronic RRT. Cost utility decreased with increasing age exceeding 1.0 million €QALY in the older groups.
  
  
  CONCLUSIONS
  In general, the CU ratio of acute RRT is poor. However, it is acceptable in patients with renal recovery who survive for more than 1 year.
authors.affiliation: Intensive Care Unit, Division of Anaesthesiology and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, PO Box 340, 00029 HUS Helsinki, Finland. annika.laukkanen@hus.fi
authors.forename: Annika
authors.initials: A
authors.lastname: Laukkanen
authors.forename: Linda
authors.initials: L
authors.lastname: Emaus
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
mesh_terms: D058186:Acute Kidney Injury / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000191:economics*; D013997:Time Factors