CostEffectiveness of High Dose Hemodialysis in Co

Authors: Anna Trisia Beby Tom Cornelis Raymund Zinck Frank Xiaoqing Liu

Publish Date: 2016/09/23

Volume: 33, Issue: 11, Pages: 2032-2048

PDF Link

Abstract

In the Netherlands the current standard of care for treating patients with endstage renal disease is three sessions of incenter hemodialysis conventional ICHD However the literature indicates that high dose hemodialysis high dose HD may provide better health outcome such as survival and quality of life The objective of this study was to determine the costeffectiveness of high dose HD both incenter and at home in comparison to conventional ICHD from a Dutch payer’s perspective over a 5 year period Additionally the costeffectiveness of conventional HD at home in comparison to conventional ICHD will be analysedA Markov model was developed assuming 28day treatment cycles and was populated with data from Dutch and international renal registries official tariffs and medical literature Univariable and probabilistic sensitivity analyses were performed to test the robustness of the resultsUsing publicly available tariffs from the Dutch Healthcare Authority Nederlandse Zorgautoriteit of 2015 doing high dose ICHD instead of conventional ICHD shows an incremental costeffectiveness ratio ICER of €275747 per qualityadjusted life year QALY gained In contrast the ICER of high dose HD at home in comparison to conventional ICHD is €3248 per gained QALY The final analysis shows that conventional HD at home is less costly per patient −€3063 than conventional ICHD and results in health benefit improvement +0249 QALYs and is therefore regarded as cost savingTreating dialysis patients with conventional HD at home shows to be cost saving in comparison to conventional ICHD However the magnitude of clinical benefit of high dose HD at home is over two times greater than the clinical benefit of conventional HD at home According to our analysis from a payer’s perspective high dose HD should be offered as a home therapy to obtain its clinical benefits in a costeffective manner Future research should consider our findings alongside societal factors such as patient preference monitoring cost for the home patient productivity loss and capacity

Keywords: