Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment

Wolfgang C. Winkelmayer, Milton C. Weinstein, Murray A. Mittleman, Robert J. Glynn and Joseph S. Pliskin
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Wolfgang C. Winkelmayer: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
Milton C. Weinstein: Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
Murray A. Mittleman: Department of Epidemiology, Harvard School of Public Health, and the Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Robert J. Glynn: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
Joseph S. Pliskin: Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer Sheba, Israel

Medical Decision Making, 2002, vol. 22, issue 5, 417-430

Abstract: This article synthesizes the evidence on the cost-effectiveness of renal replacement therapy and discusses the findings in light of the frequent practice of using the cost-effectiveness of hemodialysis as a benchmark of societal willingness to pay. The authors conducted a meta-analytic review of the medical and economic literature for economic evaluations of hemodialysis, peritoneal dialysis, and kidney transplantation. Cost-effectiveness ratios were translated into 2000 U.S. dollars per life-year (LY) saved. Thirteen studies published between 1968 and 1998 provided such information. The cost-effectiveness of center hemodialysis remained within a narrow range of $55,000 to $80,000/LY in most studies despite considerable variation in methodology and imputed costs. The cost-effectiveness of home hemodialysis was found to be between $33,000 and $50,000/LY. Kidney transplantation, however, has become more cost-effective over time, approaching $10,000/LY. Estimates of the cost per life-year gained from hemodialysis have been remarkably stable over the past 3 decades, after adjusting for price levels. Uses of the cost-effectiveness ratio of $55,000/LY for center hemodialysis as a lower boundary of society’s willingness to pay for an additional life-year can be supported under certain assumptions.

Keywords: cost-effectiveness analysis; dialysis; kidney transplantation; meta-analysis (search for similar items in EconPapers)
Date: 2002
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:22:y:2002:i:5:p:417-430

DOI: 10.1177/027298902236927

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