title: Cost-Effectiveness Analysis of High-Efficiency Hemodiafiltration Versus Low-Flux Hemodialysis Based on the Canadian Arm of the CONTRAST Study.
abstract: OBJECTIVE
  The aim of this study was to assess the cost effectiveness of high-efficiency on-line hemodiafiltration (OL-HDF) compared with low-flux hemodialysis (LF-HD) for patients with end-stage renal disease (ESRD) based on the Canadian (Centre Hospitalier de l'Université de Montréal) arm of a parallel-group randomized controlled trial (RCT), the CONvective TRAnsport STudy.
  
  
  METHODS
  An economic evaluation was conducted for the period of the RCT (74 months). In addition, a Markov state transition model was constructed to simulate costs and health benefits over lifetime. The primary outcome was costs per quality-adjusted life-year (QALY) gained. The analysis had the perspective of the Quebec public healthcare system.
  
  
  RESULTS
  A total of 130 patients were randomly allocated to OL-HDF (n = 67) and LF-HD (n = 63). The cost-utility ratio of OL-HDF versus LF-HD was Can$53,270 per QALY gained over lifetime. This ratio was fairly robust in the sensitivity analysis. The cost-utility ratio was lower than that of LF-HD compared with no treatment (immediate death), which was Can$93,008 per QALY gained.
  
  
  CONCLUSIONS
  High-efficiency OL-HDF can be considered a cost-effective treatment for ESRD in a Canadian setting. Further research is needed to assess cost effectiveness in other settings and healthcare systems.
authors.affiliation: Department of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.|St. Luc Hospital, Montréal, Canada.
authors.forename: Renee
authors.initials: R
authors.lastname: Lévesque
authors.affiliation: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany. daniele.marcelli@fmc-ag.de.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Department of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.|Notre-Dame Hospital, Montréal, Canada.
authors.forename: Héloïse
authors.initials: H
authors.lastname: Cardinal
authors.affiliation: St. Luc Hospital, Montréal, Canada.
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Caron
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.|Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Nephrology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.|Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.affiliation: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.affiliation: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.affiliation: Frankfurt School of Finance and Management, Frankfurt Am Main, Germany. A.Gandjour@fs.de.
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
mesh_terms: D000368:Aged; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D017583:Hemodiafiltration / Q000191:economics* / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods*