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


  • 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)


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.

Suggested Citation

  • S. Laplante & F. X. Liu & B. Culleton & A. Bernardo & Denise King & P. Hudson, 2016. "The Cost Effectiveness of High-Dose versus Conventional Haemodialysis: a Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 14(2), pages 185-193, April.
  • Handle: RePEc:spr:aphecp:v:14:y:2016:i:2:d:10.1007_s40258-015-0212-3
    DOI: 10.1007/s40258-015-0212-3

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    References listed on IDEAS

    1. Takeru Shiroiwa & Yoon-Kyoung Sung & Takashi Fukuda & Hui-Chu Lang & Sang-Cheol Bae & Kiichiro Tsutani, 2010. "International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 422-437.
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    Cited by:

    1. Suzanne Laplante & Frank X. Liu & Bruce Culleton & Angelito Bernardo & Denise King & Pollyanna Hudson, 2016. "Authors’ Reply to Gandjour “The Cost Effectiveness of High-Dose Versus Conventional Haemodialysis: A Systematic Review”," Applied Health Economics and Health Policy, Springer, vol. 14(6), pages 731-732, December.

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