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A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Author

Listed:
  • Ellen Busink

    (Fresenius Medical Care)

  • Dana Kendzia

    (Fresenius Medical Care)

  • Fatih Kircelli

    (Fresenius Medical Care)

  • Sophie Boeger

    (Fresenius Medical Care)

  • Jovana Petrovic

    (Fresenius Medical Care)

  • Helen Smethurst

    (Mtech Access Ltd)

  • Stephen Mitchell

    (Mtech Access Ltd)

  • Christian Apel

    (Fresenius Medical Care)

Abstract

Objectives Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. Methods A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). Results In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. Conclusions Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.

Suggested Citation

  • Ellen Busink & Dana Kendzia & Fatih Kircelli & Sophie Boeger & Jovana Petrovic & Helen Smethurst & Stephen Mitchell & Christian Apel, 2023. "A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(3), pages 377-392, April.
    • Handle: RePEc:spr:eujhec:v:24:y:2023:i:3:d:10.1007_s10198-022-01478-2
    DOI: 10.1007/s10198-022-01478-2
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    References listed on IDEAS

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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. Naren Kumar Surendra & Mohd Rizal Abdul Manaf & Lai Seong Hooi & Sunita Bavanandan & Fariz Safhan Mohamad Nor & Shahnaz Shah Firdaus Khan & Ong Loke Meng & Abdul Halim Abdul Gafor, 2019. "Cost utility analysis of end stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-16, October.
    3. Catrin Treharne & Frank Liu & Murat Arici & Lydia Crowe & Usman Farooqui, 2014. "Peritoneal Dialysis and In-Centre Haemodialysis: A Cost-Utility Analysis from a UK Payer Perspective," Applied Health Economics and Health Policy, Springer, vol. 12(4), pages 409-420, August.
    4. Matthew J Page & Joanne E McKenzie & Patrick M Bossuyt & Isabelle Boutron & Tammy C Hoffmann & Cynthia D Mulrow & Larissa Shamseer & Jennifer M Tetzlaff & Elie A Akl & Sue E Brennan & Roger Chou & Jul, 2021. "The PRISMA 2020 statement: An updated guideline for reporting systematic reviews," PLOS Medicine, Public Library of Science, vol. 18(3), pages 1-15, March.
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    1. Richard Dumbill & Simon Knight & James Hunter & John Fallon & Daniel Voyce & Jacob Barrett & Matt Ellen & Elizabeth Conroy & Ian SD Roberts & Tim James & Gabrielle Allen & Jennifer Brook & Annemarie W, 2025. "Prolonged normothermic perfusion of the kidney prior to transplantation: a historically controlled, phase 1 cohort study," Nature Communications, Nature, vol. 16(1), pages 1-15, December.

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    More about this item

    Keywords

    Systematic review; Renal replacement therapy; Patient pathway management; Patient choice; Economic evaluation; Healthcare policy;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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