title: High-dose hemodialysis versus conventional in-center hemodialysis: a cost-utility analysis from a UK payer perspective.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of high-dose hemodialysis (HD) versus conventional in-center HD (ICHD), over a lifetime time horizon from the UK payer's perspective.
  
  
  METHODS
  We used a Markov modeling approach to compare high-dose HD (in-center or at home) with conventional ICHD using current and hypothetical home HD reimbursement tariffs in England. Sensitivity analyses tested the robustness of the results. The main outcome measure was the incremental cost-effectiveness ratio (ICER) expressed as a cost per quality-adjusted life-year (QALY).
  
  
  RESULTS
  Over a lifetime, high-dose HD in-center (5 sessions/wk) is associated with higher per-patient costs and QALYs (increases of £108,713 and 0.862, respectively) versus conventional ICHD. The corresponding ICER (£126,106/QALY) indicates that high-dose HD in-center is not cost-effective versus conventional ICHD at a UK willingness-to-pay threshold of £20,000 to £30,000. High-dose HD at home is associated with lower total costs (£522 less per patient) and a per-patient QALY increase of 1.273 compared with ICHD under the current Payment-by Results reimbursement tariff (£456/wk). At an increased home HD tariff (£575/wk), the ICER for high-dose HD at home versus conventional ICHD is £17,404/QALY. High-dose HD at home had a 62% to 84% probability of being cost-effective at a willingness-to-pay threshold of £20,000 to £30,000/QALY.
  
  
  CONCLUSIONS
  Although high-dose HD has the potential to offer improved clinical and quality-of-life outcomes over conventional ICHD, under the current UK Payment-by Results reimbursement scheme, it would be considered cost-effective from a UK payer perspective only if conducted at home.
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, USA. Electronic address: xiaoqing_liu@baxter.com.
authors.forename: Frank Xiaoqing
authors.initials: FX
authors.lastname: Liu
authors.affiliation: Abacus International, Oxfordshire, UK.
authors.forename: Catrin
authors.initials: C
authors.lastname: Treharne
authors.affiliation: Baxter International UK, Compton, UK.
authors.forename: Murat
authors.initials: M
authors.lastname: Arici
authors.affiliation: Abacus International, Oxfordshire, UK.
authors.forename: Lydia
authors.initials: L
authors.lastname: Crowe
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Culleton
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008390:Markov Chains; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods / Q000401:mortality; D006113:United Kingdom
keywords: cost-effectiveness analysis; cost-utility analysis; end-stage renal disease; high-dose hemodialysis; in-center hemodialysis