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. 2016 Sep 22:8:531-540.
doi: 10.2147/CEOR.S109649. eCollection 2016.

Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

Francesco Ramponi  1 , Claudio Ronco  2 , Giacomo Mason  3 , Enrico Rettore  4 , Daniele Marcelli  5 , Francesca Martino  2 , Mauro Neri  6 , Alejandro Martin-Malo  7 , Bernard Canaud  8 , Francesco Locatelli  9
Affiliations

Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

Francesco Ramponi et al. Clinicoecon Outcomes Res. .

Abstract

Background: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.

Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed.

Results: An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients.

Conclusion: HDF can be considered cost-effective compared to HF-HD.

Keywords: cost-effectiveness; hemodiafiltration; hemodialysis.

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Figures

Figure 1
Figure 1
Structure of the Markov model. Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis; HRQoL, health-related quality of life.
Figure 2
Figure 2
Cost-effectiveness plane for 50-year-old male patients. Abbreviation: QALYs, quality-adjusted life years.
Figure 3
Figure 3
Cost-effectiveness acceptability curves for male patients aged 50 years old treated with high-flux HD or online HDF. Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis.
Figure 4
Figure 4
Cost-effectiveness acceptability curves for female and male patients aged 40, 50, and 60 years on hemodiafiltration.
Figure 5
Figure 5
Cost-effectiveness plane for 50-year-old male patients, using overall health-related quality of life coefficients. Abbreviation: QALYs, quality-adjusted life years.
Figure 6
Figure 6
Cost-effectiveness acceptability curves for female and male patients aged 40, 50, and 60 years on hemodiafiltration (alternative cost setting).
Figure 7
Figure 7
Cost-effectiveness acceptability curves for diabetics and nondiabetics.
See this image and copyright information in PMC

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