OBJECTIVES: Renal replacement therapy (RRT) dependent acute renal failure (ARF) is associated with substantial mortality and high economic burden. Though economic studies are available for the intermittent or continuous RRTs, it is yet to establish which RRT technique is comparatively more cost-effective with respect to other. Hence, we systematically reviewed the current literature on the cost-effectiveness analysis (CEA) of intermittent or continuous RRTs in ARF patients.

METHODS: PubMed, EMBASE, and Cochrane databases were searched for the published CEA of intermittent and continuous RRTs. Two researchers independently screened search results and extracted data for 1) key model design and assumptions: time horizon, study perspective, direct/indirect cost 2) Cost effectiveness results: cost, QALY, incremental cost-effectiveness ratio (ICER) and 3) Sensitivity analysis. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the reporting of the included studies.

RESULTS: Of 729 articles identified, 3 CEAs fulfilled the inclusion criteria. Included CEAs were from Canada, US, and Belgium; and adopted payer’s perspective. Only one of the study followed CHEERS statement for reporting economic evaluation. Two of the studies used Markov model, while none included the indirect cost; time horizon across studies ranged from 2 years to lifetime. Total cost of intermittent RRT was less than continuous RRT (96,635 C$ vs. 100,314 C$) in the oldest of three studies. Whereas, in the latest study total cost of CRRT was less than IRRT (37780 $ vs. 39448 $) and associated ICER of CRRT versus IRRT was negative in base case (−116121 $), 5-year (−106527 $) and lifetime (−196956 $) horizon.

CONCLUSIONS: Available CEA of RRTs shows conflicting finding. An older CEA shows intermittent RRT to be less costly than continuous RRT; contrary, recent analysis finds continuous RRT to be cost-effective compared to the intermittent RRT. Hence, the generalizability of CEAs is limited and country-specific analyses are needed.