Dialysis for end-stage renal disease: determining a cost-effective approach

L. Kirby, Luke David Vale

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Objective: Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many areas of uncertainty about which method of RRT should be chosen. This paper reports an economic model based on a systematic review that attempts to determine which method of dialysis, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis, a patient should have as the initial method of RRT.

Methods: A systematic review and a costing exercise carried out in a Scottish hospital were used to populate a Markov model. Scenario analysis was used to model plausible variations in variables included in the model.

Results: In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable variability, ranging from between pound5,000 to pound 51,000. The higher costs per life-year were associated with minimum estimates of additional survival for a patient starting RRT on hospital hemodialysis.

Conclusion: It may be more cost-effective to manage patients starting on RRT with hospital hemodialysis than CAPD. This has particular implications for the United Kingdom, given that up to 50% of new patients receive CAPD.

Original languageEnglish
Pages (from-to)181-189
Number of pages8
JournalInternational Journal of Technology Assessment in Health Care
Issue number2
Publication statusPublished - 2001


  • cost-effectiveness
  • hemodialysis
  • CAPD
  • Markov modeling
  • systematic review


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