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

Author

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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)

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.

Suggested Citation

  • Wolfgang C. Winkelmayer & Milton C. Weinstein & Murray A. Mittleman & Robert J. Glynn & Joseph S. Pliskin, 2002. "Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment," Medical Decision Making, , vol. 22(5), pages 417-430, October.
    • Handle: RePEc:sae:medema:v:22:y:2002:i:5:p:417-430
    DOI: 10.1177/027298902236927
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    References listed on IDEAS

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    1. de Wit, G.Ardine & Ramsteijn, Paul G & de Charro, Frank Th, 1998. "Economic evaluation of end stage renal disease treatment," Health Policy, Elsevier, vol. 44(3), pages 215-232, June.
    2. Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
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    1. Kontodimopoulos, Nick & Niakas, Dimitris, 2008. "An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy," Health Policy, Elsevier, vol. 86(1), pages 85-96, April.
    2. Amitabh Chandra & Anupam B. Jena & Jonathan S. Skinner, 2011. "The Pragmatist's Guide to Comparative Effectiveness Research," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 27-46, Spring.
    3. Mohsen Yaghoubi & Sonya Cressman & Louisa Edwards & Steven Shechter & Mary M. Doyle-Waters & Paul Keown & Ruth Sapir-Pichhadze & Stirling Bryan, 2023. "A Systematic Review of Kidney Transplantation Decision Modelling Studies," Applied Health Economics and Health Policy, Springer, vol. 21(1), pages 39-51, January.
    4. Jan Jürgensen & Robert Ikenberg & Roger-Axel Greiner & Volker Hösel, 2015. "Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 377-390, May.
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    7. Murat Kurt & Mark S. Roberts & Andrew J. Schaefer & M. Utku Ünver, 2011. "Valuing Prearranged Paired Kidney Exchanges: A Stochastic Game Approach," Boston College Working Papers in Economics 785, Boston College Department of Economics, revised 14 Oct 2011.
    8. Milton C. Weinstein, 2005. "Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help? 16th Annual Herbert Lourie Memorial Lecture on Health Policy," Center for Policy Research Policy Briefs 30, Center for Policy Research, Maxwell School, Syracuse University.
    9. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    10. Jan Jürgensen & Wolfgang Arns & Bastian Haß, 2010. "Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(1), pages 15-25, February.
    11. Ewa Orlewska & Piotr Mierzejewski, 2003. "Project of Polish guidelines for conducting pharmacoeconomic evaluations in comparison to international health economic guidelines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 4(4), pages 296-303, December.

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