A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Abstract

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.

Cost-effectiveness analysis of haemodialysis and comprehensive conservative care in managing end-stage renal disease in Abuja, Nigeria

“…Renal replacement therapy (RRT), such as kidney transplantation, peritoneal dialysis and haemodialysis, is a lifesaving but costly treatment for ESRD patients [3]. While kidney transplantation is the optimal RRT, dialysis remains the feasible RRT for ESRD patients because of the shortage of kidneys and the medical ineligibility of some patients for transplation [4,5]. Haemodialysis is the predominant RRT option in Nigeria [2].…”

“…Most published studies on the cost-effectiveness of RRT have focused on high-income countries and compared alternative dialysis types or dialysis modalities with different intensities [1,3,4]. Many studies reported average cost-effectiveness ratios that are less useful for decisionmaking when moving between alternative modalities than incremental cost-effectiveness ratios (ICERs) [1].…”

“…4 shows the total DALY averted for the study population of 87 respondents, which is 9,959.8 DALYs. Discounted at 3%, DALYs averted is 9,669.7.…”

Appropriateness of the dialysis modality selection process: A cross-sectional study

“…[ 2 , 3 , 10 , 11 ] Authors of a recent systematic review suggested a more comprehensive cost-effectiveness approach that considers different renal replacement therapy (RRTs) along the patient pathway since switching between dialysis modalities is often essential. [ 11 ] According to expert opinion, [ 12 , 13 ] PD should ideally reach 30% to 45% of patients starting RRT. However, the use of PD is considerably low in clinical practice.…”

“…[2,3] Similar to hemodialysis (HD), peritoneal dialysis (PD) is an effective technique for the treatment of ESKD, [4][5][6][7][8][9] but most economic evaluations indicate that it is more cost-effective. [2,3,10,11] Authors of a recent systematic review suggested a more comprehensive cost-effectiveness approach that considers different renal replacement therapy (RRTs) along the patient pathway since switching between dialysis modalities is often essential. [11] According to expert opinion, [12,13] PD should ideally reach 30% to 45% of patients starting RRT.…”