Objectives
Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients.
Methods
A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]).
Results
In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions.
Conclusions
Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances.
Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.
canal inhibitors prescription differences substist at T+1 (p=0,0151), as well as insulin (p=0,0025), and metformin (p=0,0318). At T+2, the only difference is the prescription of amlodipin (p=0,0003). In the cohort, prescription of opioids (p=0,002), glinids (p=0,0037), iron (p=0,028), acetaminophen(p=0,0011) are increasing, while metformin, beta-blockers (p=0,0009), diuretic (p , 0,0001) and statins (p=0,029) are decreasing. These results are confirmed in the sensitivity analyses. Conclusions: Even unknowingly practitioners are differentiating prescription between the high risk group and the low risk group. Such differences indicate the possibility to personalize patient follow-up with no interference on quality of care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.