High-Dose Hemodialysis versus Conventional In-Center Hemodialysis- A Cost-Utility Analysis from a UK Payer Perspective

Jan 1, 2015, 00:00
10.1016/j.jval.2014.10.002
https://www.valueinhealthjournal.com/article/S1098-3015(14)04727-5/fulltext
Title : High-Dose Hemodialysis versus Conventional In-Center Hemodialysis- A Cost-Utility Analysis from a UK Payer Perspective
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(14)04727-5&doi=10.1016/j.jval.2014.10.002
First page : 17
Section Title : Economic Evaluation
Open access? : Yes
Section Order : 7

Objective

To investigate the cost-effectiveness of high-dose hemodialysis (HD) versus conventional in-center HD (ICHD), over a lifetime time horizon from the UK payer’s perspective.

Methods

We used a Markov modeling approach to compare high-dose HD (in-center or at home) with conventional ICHD using current and hypothetical home HD reimbursement tariffs in England. Sensitivity analyses tested the robustness of the results. The main outcome measure was the incremental cost-effectiveness ratio (ICER) expressed as a cost per quality-adjusted life-year (QALY).

Results

Over a lifetime, high-dose HD in-center (5 sessions/wk) is associated with higher per-patient costs and QALYs (increases of £108,713 and 0.862, respectively) versus conventional ICHD. The corresponding ICER (£126,106/QALY) indicates that high-dose HD in-center is not cost-effective versus conventional ICHD at a UK willingness-to-pay threshold of £20,000 to £30,000. High-dose HD at home is associated with lower total costs (£522 less per patient) and a per-patient QALY increase of 1.273 compared with ICHD under the current Payment-by Results reimbursement tariff (£456/wk). At an increased home HD tariff (£575/wk), the ICER for high-dose HD at home versus conventional ICHD is £17,404/QALY. High-dose HD at home had a 62% to 84% probability of being cost-effective at a willingness-to-pay threshold of £20,000 to £30,000/QALY.

Conclusions

Although high-dose HD has the potential to offer improved clinical and quality-of-life outcomes over conventional ICHD, under the current UK Payment-by Results reimbursement scheme, it would be considered cost-effective from a UK payer perspective only if conducted at home.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Specific Diseases & Conditions
  • Urinary/Kidney Disorders
Tags :
  • cost-effectiveness analysis
  • cost-utility analysis
  • end-stage renal disease
  • high-dose hemodialysis
  • in-center hemodialysis
Regions :
  • Africa
  • Eastern and Central Europe
  • Middle East
ViH Article Tags :