Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan

Abstract

Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.

The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations

“…The study population of all studies were patients with ESKD, but only four studies described characteristics of the base case population [20,24,27,29]. Five of the ten studies conducted a CUA [20][21][22][23][24], one conducted a CEA [25], and four conducted both a CEA and CUA [26][27][28][29]. Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively.…”

“…Five of the ten studies conducted a CUA [20][21][22][23][24], one conducted a CEA [25], and four conducted both a CEA and CUA [26][27][28][29]. Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively. Four studies were conducted from a public healthcare perspective [21,22,24,27], three from a societal perspective [20,23,29] and three from a third-party payer perspective [25,26,28].…”

“…Eight studies were model-based economic evaluations using Markov models [20][21][22][23][26][27][28][29] and the remaining two studies were a multicenter cross-section study [24] and a retrospective cohort study [25], respectively. Four studies were conducted from a public healthcare perspective [21,22,24,27], three from a societal perspective [20,23,29] and three from a third-party payer perspective [25,26,28]. Figure 2 shows the proportions of included studies that complied with applicable items of the CHEERS checklist.…”

“…Although de Wit et al [29] claimed to have adopted a societal perspective, they excluded time costs and indirect costs (productivity loss) in the cost analysis. Six of the ten studies differentiated between costs in the first year and subsequent years after initiation of KRT [22,24,25,[27][28][29]. This cost differentiation is necessary given that KT costs accumulate primarily in the first year and decrease substantially in subsequent years.…”

The Need for Kidney Transplantation in Low- and Middle-Income Countries in 2012

“…7 Costs of maintaining a functioning kidney graft in high-income countries range from approximately U.S. $10,000 to $20,000 per person per year: by comparison, costs of in-center hemodialysis range from approximately U.S. $50,000 to $90,000 per person per year. [8][9][10][11] Given that kidney transplantation is also associated with a substantial increase in life years compared to remaining on the waiting list, 12 as well as significant gains in quality of life, 13 maximizing the rate of transplantation is considered an economically dominant strategy for health systems in high-income countries, and this is typically reflected in health policies with respect to organ donation and transplantation. Economic evaluations conducted in upper-to middle-income countries have demonstrated that transplanting a greater proportion of dialysis patients in this setting would similarly result in cost savings from the perspective of a single payer and an increase in life years gained.…”