title: The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study.
abstract: BACKGROUND
  Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD).
  
  
  METHODS
  A cost-utility analysis was performed using a Markov model. It included data from the Convective Transport Study (CONTRAST), a randomized controlled trial that compared online HDF with low-flux HD. Costs were estimated using a societal perspective. Probabilistic sensitivity analyses were performed to study uncertainty.
  
  
  RESULTS
  Total annual costs for HDF and HD were €88 622±19,272 and €86,086±15,945, respectively (in 2009 euros). When modelled over a 5-year period, the incremental cost per quality-adjusted life year (QALY) of HDF versus HD was €287,679. Sensitivity analyses revealed that this amount will not fall below €140,000, even under the most favourable assumptions like a high-convection volume (>20.3 L).
  
  
  CONCLUSIONS
  Based on accepted societal willingness-to-pay thresholds, HDF cannot be considered a cost-effective treatment for patients with end-stage renal disease at present. Apparently, minor additional costs of HDF are not counterbalanced by a relevant QALY gain.
authors.affiliation: Department of Nephrology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Albert H A
authors.initials: AH
authors.lastname: Mazairac
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
authors.forename: E Lars
authors.initials: EL
authors.lastname: Penne
authors.forename: Neelke C
authors.initials: NC
authors.lastname: van der Weerd
authors.forename: Claire H
authors.initials: CH
authors.lastname: den Hoedt
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
authors.forename: Piet M
authors.initials: PM
authors.lastname: ter Wee
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017583:Hemodiafiltration / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics*; D015996:Survival Rate
keywords: cost–utility analysis; haemodiafiltration; haemodialysis