Cost-Effectiveness Analysis of High-Efficiency Hemodiafiltration Versus Low-Flux Hemodialysis Based on the Canadian Arm of the CONTRAST Study

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Abstract

Aim

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.

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Most cited references 30

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Economic evaluation of dialysis therapies.

Scott W Klarenbach, Marcello Tonelli, Betty K Chui … (2014)

The prevalence of chronic kidney disease and end-stage renal disease requiring dialysis therapy continues to increase worldwide, and despite technological advances, treatment remains resource intensive. Thus, the increasing burden of dialysis therapy on finite health-care budgets is an important consideration. The principles of allocative efficiency and the concept of 'opportunity cost' can be used to assess whether dialysis is economically justified; if dialysis is to be provided, cost-minimization and cost-utility analyses can be used to identify the most efficient dialysis modality. Existing studies have examined the cost, and where relevant the effectiveness, of the various currently available peritoneal dialysis and haemodialysis modalities. In this Review, we discuss variations in the intrinsic costs of the available dialysis modalities as well as other factors, such as variation by country, available health-care infrastructures, the timing of dialysis initiation and renal transplantation. We draw on data from robust micro-costing studies of the various dialysis modalities in Canada to highlight key issues.

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Canadian Valuation of EQ-5D Health States: Preliminary Value Set and Considerations for Future Valuation Studies

Nick Bansback, Aki Tsuchiya, John Brazier … (2012)

Background The EQ-5D is a preference based instrument which provides a description of a respondent's health status, and an empirically derived value for that health state often from a representative sample of the general population. It is commonly used to derive Quality Adjusted Life Year calculations (QALY) in economic evaluations. However, values for health states have been found to differ between countries. The objective of this study was to develop a set of values for the EQ-5D health states for use in Canada. Methods Values for 48 different EQ-5D health states were elicited using the Time Trade Off (TTO) via a web survey in English. A random effect model was fitted to the data to estimate values for all 243 health states of the EQ-5D. Various model specifications were explored. Comparisons with EQ-5D values from the UK and US were made. Sensitivity analysis explored different transformations of values worse than dead, and exclusion criteria of subjects. Results The final model was estimated from the values of 1145 subjects with socio-demographics broadly representative of Canadian general population with the exception of Quebec. This yielded a good fit with observed TTO values, with an overall R2 of 0.403 and a mean absolute error of 0.044. Conclusion A preference-weight algorithm for Canadian studies that include the EQ-5D is developed. The primary limitations regarded the representativeness of the final sample, given the language used (English only), the method of recruitment, and the difficulty in the task. Insights into potential issues for conducting valuation studies in countries as large and diverse as Canada are gained.

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The cost-effectiveness of increasing kidney transplantation and home-based dialysis.

Kirsten Howard, Glenn Salkeld, Sarah White … (2009)

Renal replacement therapy (RRT) consumes sizable proportions of health budgets internationally, but there is considerable variability in choice of RRT modality among and within countries with major implications for health outcomes and costs. We aimed to quantify these implications for increasing kidney transplantation and improving the rate of home-based dialysis. A multiple cohort Markov model was used to assess costs and health outcomes of RRT for new end-stage kidney disease (ESKD) patients in Australia for 2005-2010, using a health-care funder perspective. Patient characteristics and current practice patterns were based on the ANZDATA Registry. Two proposed changes were modelled: (i) increasing kidney transplants by between 10% and 50% by 2010; and (ii) increasing home haemodialysis (HD) and peritoneal dialysis (PD) to the highest rates observed among Australian centres. We assessed costs (Australian dollars), survival and quality-adjusted survival, and cost-effectiveness. The number of new ESKD patients in 2010 was estimated to be 2700, with annual RRT costs of about $A700 million; cumulative costs (2005-2010) were $A5 billion. Increasing transplants by 10-50% saves between $A5.8 and $A26.2 million, and increases quality-adjusted life years (QALYs) by 130-658 QALYs. Switching new patients from hospital HD to (i) home HD saves $A46.6 million by 2010; or (ii) PD saves $A122.1 million. These clinical practice changes reduce costs, improve patient quality of life and, in the case of transplantation, increase survival. Planning for RRT services should incorporate efforts to maximize rates of transplantation and to encourage home-based over hospital-based dialysis to optimize cost-effectiveness in RRT service delivery.

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Author and article information

Contributors

Daniele Marcelli: daniele.marcelli@fmc-ag.de

Afschin Gandjour: A.Gandjour@fs.de

Journal

Journal ID (nlm-ta): Appl Health Econ Health Policy

Journal ID (iso-abbrev): Appl Health Econ Health Policy

Title: Applied Health Economics and Health Policy

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1175-5652

ISSN (Electronic): 1179-1896

Publication date (Electronic): 14 June 2015

Publication date PMC-release: 14 June 2015

Publication date (Print): 2015

Volume: 13

Issue: 6

Pages: 647-659

Affiliations

[ ]Department of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada

[ ]St. Luc Hospital, Montréal, Canada

[ ]EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany

[ ]Notre-Dame Hospital, Montréal, Canada

[ ]Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands

[ ]Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands

[ ]Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

[ ]Department of Nephrology, University Medical Center, Utrecht, The Netherlands

[ ]Frankfurt School of Finance and Management, Frankfurt Am Main, Germany

Article

Publisher ID: 179

DOI: 10.1007/s40258-015-0179-0

PMC ID: 4661220

PubMed ID: 26071951

SO-VID: a91d62c1-99d4-4a4f-9090-d49f35ca47f2

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Cost-Effectiveness Analysis of High-Efficiency Hemodiafiltration Versus Low-Flux Hemodialysis Based on the Canadian Arm of the CONTRAST Study

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Most cited references 30

Economic evaluation of dialysis therapies.

Canadian Valuation of EQ-5D Health States: Preliminary Value Set and Considerations for Future Valuation Studies

The cost-effectiveness of increasing kidney transplantation and home-based dialysis.

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Cited by 11

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