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

L. Kirby, Luke David Vale

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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
Volume17
Issue number2
DOIs
Publication statusPublished - 2001

Keywords

  • cost-effectiveness
  • hemodialysis
  • CAPD
  • Markov modeling
  • systematic review
  • AMBULATORY PERITONEAL-DIALYSIS
  • HEMODIALYSIS

Cite this

Dialysis for end-stage renal disease: determining a cost-effective approach. / Kirby, L.; Vale, Luke David.

In: International Journal of Technology Assessment in Health Care, Vol. 17, No. 2, 2001, p. 181-189.

Research output: Contribution to journalArticle

@article{ae8c3d42f1854697a19440d48353b994,
title = "Dialysis for end-stage renal disease: determining a cost-effective approach",
abstract = "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.",
keywords = "cost-effectiveness, hemodialysis, CAPD, Markov modeling, systematic review, AMBULATORY PERITONEAL-DIALYSIS, HEMODIALYSIS",
author = "L. Kirby and Vale, {Luke David}",
year = "2001",
doi = "10.1017/S0266462300105045",
language = "English",
volume = "17",
pages = "181--189",
journal = "International Journal of Technology Assessment in Health Care",
issn = "0266-4623",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - Dialysis for end-stage renal disease: determining a cost-effective approach

AU - Kirby, L.

AU - Vale, Luke David

PY - 2001

Y1 - 2001

N2 - 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.

AB - 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.

KW - cost-effectiveness

KW - hemodialysis

KW - CAPD

KW - Markov modeling

KW - systematic review

KW - AMBULATORY PERITONEAL-DIALYSIS

KW - HEMODIALYSIS

U2 - 10.1017/S0266462300105045

DO - 10.1017/S0266462300105045

M3 - Article

VL - 17

SP - 181

EP - 189

JO - International Journal of Technology Assessment in Health Care

JF - International Journal of Technology Assessment in Health Care

SN - 0266-4623

IS - 2

ER -