The Cost Effectiveness of High-Dose versus Conventional Haemodialysis: a Systematic Review

S. Laplante, F. X. Liu, B. Culleton, A. Bernardo, Denise King () and P. Hudson
Additional contact information
S. Laplante: Baxter Healthcare Corporation
F. X. Liu: Baxter Healthcare Corporation
B. Culleton: Baxter Healthcare Corporation
A. Bernardo: Baxter Healthcare Corporation
Denise King: Abacus International
P. Hudson: Abacus International

Applied Health Economics and Health Policy, 2016, vol. 14, issue 2, No 6, 185-193

Abstract: Abstract Background End-stage renal disease (ESRD) is fatal if untreated. In the absence of transplant, approximately 50 % of dialysis patients die within 5 years. Although more frequent and/or longer haemodialysis (high-dose HD) improves survival, this regimen may add to the burden on dialysis services and healthcare costs. This systematic review summarised the cost effectiveness of high-dose HD compared with conventional HD. Methods English language publications reporting the cost-utility/effectiveness of high-dose HD in adults with ESRD were identified via a search of MEDLINE, Embase, and the Cochrane Library. Publications comparing any form of high-dose HD with conventional HD were reviewed. Results Seven publications (published between 2003 and 2014) reporting cost-utility analyses from the public healthcare payer perspective were identified. High-dose HD in-centre was compared with in-centre conventional HD in one US model; all other analyses (UK, Canada) compared high-dose HD at home with in-centre conventional HD (n = 5) or in-centre/home conventional HD (n = 1). The time horizon varied from one year to lifetime. Similar survival for high-dose HD and conventional HD was assumed, with the impact of higher survival only assessed in the sensitivity analyses of three models. High-dose HD at home was found to be cost effective compared with conventional HD in all six analyses. The analysis comparing high-dose HD in-centre with conventional in-centre HD produced an incremental cost-effectiveness ratio generally acceptable for the USA, but not for Europe, Canada or Australia. Conclusion High-dose HD can be cost effective when performed at home. Future analyses assuming survival benefits for high-dose HD compared with conventional HD are needed.

Date: 2016
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DOI: 10.1007/s40258-015-0212-3

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