title: Cost-Effectiveness of Maintenance Hemodialysis in Japan.
abstract: The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P < 0.05, <65; P < 0.01, 65≤; not significant). MHD is a treatment that could improve the socioeconomic state of elderly patients with end-stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.
authors.affiliation: Department of Health Economics and Industrial Policy, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takura
authors.affiliation: Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
authors.affiliation: Division of Nephrology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Nephrology, Okayama Saiseikai General Hospital, Okayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hiramatsu
authors.affiliation: Department of Clinical Engineering, Maeda Institute of Renal Research, Chiba, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Department of Surgery, Sapporo Hokuyu Hospital, Hokkaido, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kukita
authors.affiliation: Department of Nephrology and Urology Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Soejima
authors.affiliation: Department of Nephrology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hirakata
authors.affiliation: Department of Urology, Mihama Hospital, Chiba, Japan.
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Miyamoto Clinic, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: International Kidney Evaluation Association Japan (IKEAJ), Tokyo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000375:Aging; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics*
keywords: Cost effectiveness analysis; Diabetic nephropathy; Hemodialysis; Incremental cost utility ratio; Quality adjusted life year