An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy

Abstract

Objectives: To estimate lifelong costs and quality adjusted life years (QALYs) of hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (Tx) in Greece, based on individual patient life expectancy.

Methods: A nationally representative patient sample on each modality, HD: N=642, PD: N=65 and Tx: N=167, was self-administered the SF-36 Health Survey, from which the preference-based SF-6D utility index was derived. Lifelong QALYs were estimated from literature-based expected remaining life years according to age, gender and modality. Cost analyses were performed from the perspective of the health system. Costs and QALYs were discounted at 5% and sensitivity analyses were performed.

Results: Estimated lifelong QALYs were 4.37 (HD), 3.94 (PD) and 16.11 (Tx) (P<0.001). Annual HD and PD costs per patient were estimated at euro36,247 and euro30,719 respectively. For Tx, average 1st year, 3-year and lifelong (undiscounted) costs were euro31,714, euro43,275 and euro151,274 respectively. Cost per QALY was higher in HD (euro60,353) compared to PD (euro54,504) and 1st year Tx (euro45,523).

Conclusions: HD is used by 75% of the Greek ESRD patients, hence cost-saving efforts must be intensified. Reconsidering supply and reimbursement policies for dialyzers and drugs, establishing satellite dialysis units and adopting telemedicine in remote areas could be explored. Wider use of PD is also in the direction of increasing cost-effectiveness. Finally, efforts are required for disseminating the idea of organ donation.