Cost-effectiveness Analysis of End-stage Renal Disease Treatments

Abstract

The cost-effectiveness of various end-stage renal disease (ESRD) treatments was compared using two different cost measures. The first measure, gross social costs, excluded output gains due to treatment, whereas the second measure, net social costs, included output gains from both market and nonmarket activities. The cost-effectiveness criterion was the cost-per-life year gained or the implicit value of a year of life. The lower the cost-per-life year gained, the more costeffective the treatment was. Four ERSD treatments were evaluated over 20 years. Home dialysis and transplantation were more cost-effective than in-center dialysis, regardless of whether gross or net social costs were used.

Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end-stage renal failure

“…[46][47][48][49][50][51][52][53][54][55][56][57] The studies with strong designs included four comparative observational studies 16,42,44,45 and two systematic reviews.…”

“…[46][47][48][49][50][51][52][53][54][55][56][57] The studies with strong designs included four comparative observational studies 16,42,44,45 and two systematic reviews. 12,43 Many of the studies reported costs and outcomes separately and/or reported costs per life-year saved, but appropriately did not calculate incremental cost-effectiveness or cost-utility ratios, because virtually all the evidence indicates that home haemodialysis costs less than hospital haemodialysis.…”

“…43,46,53,54 (Additional studies identified in the literature search had cost data relevant to the UK, but they were excluded from this section because they did not look at both costs and outcomes.) Eight studies 43,46,47,49,[52][53][54]57 had a focus on home versus hospital haemodialysis, five 16,[42][43][44]48 provided data relevant to satellite (self-care hospital) units, and seven of the studies 12,43,45,50,51,55,56 provided comparisons pertinent to the assessment of frequency of dialysis. The subsequent sections of this review provide a summary and critique of the included studies by focus of comparison, though the focus is on studies since 1990 because these more recent studies may be more relevant.…”

“…Other early studies also showed that home haemodialysis resulted in lower costs per life-year saved than hospital haemodialysis, 47,57 particularly when accounting for social costs such as output gains from market and non-market activity. 49 Ludbrook 53 used a cost-effectiveness modelling approach to show that the cost per life-year gained was lower for home than hospital dialysis, but she also demonstrated that patient selection may affect the estimated results. Despite the continuing possibility of bias from patient selection, the evidence that home haemodialysis costs less and achieves health outcomes that are most likely to be at least as good as hospital haemodialysis has led to a situation in which most other studies either simply identify cost and effects separately or use a costminimisation approach.…”

An Economic Analysis of Hand Transplantation in the United States

“…Kidney transplantation, for example provides a much higher quality of life than the alternative, outpatient dialysis. (49,50) But this increased quality of life comes at a high monetary cost. In this case, society has decided that the cost of kidney transplantation is "worth" the quality of life improvement and as such, this procedure is frequently performed.…”