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

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A Letter to the Editor to this article was published on 23 September 2016

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.

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Acknowledgments

We thank Brigitte Moore for her support in writing the manuscript.

Author contributions

Laplante S, Liu FX, Culleton B, Bernardo A: responsible for defining the scope of the project, assisting with data analysis, writing the first draft of the manuscript and editing subsequent versions.

King D: responsible for conducting the systematic review, summarizing key findings from the publications, writing the first draft of the manuscript and editing subsequent versions.

Hudson P: responsible for conducting the systematic review, summarizing key findings from the publications, writing the first draft of the manuscript and editing subsequent versions.

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Authors and Affiliations

  1. Baxter Healthcare Corporation, Deerfield, IL, 60015, USA

    S. Laplante, F. X. Liu, B. Culleton & A. Bernardo

  2. Abacus International, Bicester, UK

    Denise King & P. Hudson

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  1. S. Laplante
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  2. F. X. Liu
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Correspondence to Denise King.

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Conflict of interest

SL, AB, FXL and BC are employees of Baxter Healthcare Corporation. DK and PH have received consultancy fees from Baxter Healthcare Corporation.

Funding

This SR was funded by Baxter Healthcare Corporation.

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Laplante, S., Liu, F.X., Culleton, B. et al. The Cost Effectiveness of High-Dose versus Conventional Haemodialysis: a Systematic Review. Appl Health Econ Health Policy 14, 185–193 (2016). https://doi.org/10.1007/s40258-015-0212-3

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