title: The Cost Effectiveness of High-Dose versus Conventional Haemodialysis: a Systematic Review.
abstract: BACKGROUND
  End-stage renal disease (ESRD) is fatal if untreated. In the absence of transplant, approximately 50 % of dialysis patients die within 5 years. Although more frequent and/or longer haemodialysis (high-dose HD) improves survival, this regimen may add to the burden on dialysis services and healthcare costs. This systematic review summarised the cost effectiveness of high-dose HD compared with conventional HD.
  
  
  METHODS
  English language publications reporting the cost-utility/effectiveness of high-dose HD in adults with ESRD were identified via a search of MEDLINE, Embase, and the Cochrane Library. Publications comparing any form of high-dose HD with conventional HD were reviewed.
  
  
  RESULTS
  Seven publications (published between 2003 and 2014) reporting cost-utility analyses from the public healthcare payer perspective were identified. High-dose HD in-centre was compared with in-centre conventional HD in one US model; all other analyses (UK, Canada) compared high-dose HD at home with in-centre conventional HD (n = 5) or in-centre/home conventional HD (n = 1). The time horizon varied from one year to lifetime. Similar survival for high-dose HD and conventional HD was assumed, with the impact of higher survival only assessed in the sensitivity analyses of three models. High-dose HD at home was found to be cost effective compared with conventional HD in all six analyses. The analysis comparing high-dose HD in-centre with conventional in-centre HD produced an incremental cost-effectiveness ratio generally acceptable for the USA, but not for Europe, Canada or Australia.
  
  
  CONCLUSIONS
  High-dose HD can be cost effective when performed at home. Future analyses assuming survival benefits for high-dose HD compared with conventional HD are needed.
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, 60015, USA.
authors.forename: S
authors.initials: S
authors.lastname: Laplante
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, 60015, USA.
authors.forename: F X
authors.initials: FX
authors.lastname: Liu
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, 60015, USA.
authors.forename: B
authors.initials: B
authors.lastname: Culleton
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, 60015, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bernardo
authors.affiliation: Abacus International, Bicester, UK. dking@dresourcesgroup.com.
authors.forename: Denise
authors.initials: D
authors.lastname: King
authors.affiliation: Abacus International, Bicester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hudson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*; D013997:Time Factors; D006113:United Kingdom; D014481:United States