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. 2020 Nov 11;3(1):20-30.e1.
doi: 10.1016/j.xkme.2020.07.011. eCollection 2021 Jan-Feb.

Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure

Thomas W Ferguson  1   2 , Reid H Whitlock  2 , Ryan J Bamforth  2 , Alain Beaudry  1   2 , Joseph Darcel  3 , Michelle Di Nella  2 , Claudio Rigatto  1   2 , Navdeep Tangri  1   2 , Paul Komenda  1   2
Affiliations

Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure

Thomas W Ferguson et al. Kidney Med. .

Erratum in

Abstract

Rationale & objective: The kidney failure population is growing, necessitating the expansion of dialysis programs. These programs are costly and require a substantial amount of health care resources. Tools that accurately forecast resource use can aid efficient allocation. The objective of this study is to describe the development of an economic simulation model that incorporates treatment history and detailed modality transitions for patients with kidney disease using real-world data to estimate associated costs, utility, and survival by initiating modality.

Study design: Cost-utility model with microsimulation.

Setting & population: Adult incident maintenance dialysis patients in Canada who initiated facility-based hemodialysis (HD) or home peritoneal dialysis (PD) between 2004 and 2013.

Intervention: HD and PD.

Outcomes: Costs (related to dialysis, transplantation, infections, and hospitalizations), survival, utility, and dialysis modality mix over time.

Model perspective & timeframe: The model took the perspective of the health care payer. Patients were followed up for 10 years from initiation of dialysis. Our cost-utility analysis compared the intervention with receiving no treatment.

Results: During a 10-year time horizon, the cost-utility ratio for all patients initiating dialysis was $103,779 per quality-adjusted life-year (QALY) in comparison to no treatment. Patients who initiated with facility-based HD were treated at a cost-utility ratio of $104,880/QALY and patients who initiated with home PD were treated at a cost-utility ratio of $83,762/QALY. During this time horizon, the total mean cost and QALYs per patient were estimated at $350,774 ± $204,704 and 3.38 ± 2.05) QALYs respectively.

Limitations: The results do not include costs from the societal perspective. Rare patient trajectories were unable to be assessed.

Conclusions: This model demonstrates that patients who initiated dialysis with PD were treated more cost-effectively than those who initiated with HD during a 10-year time horizon.

Keywords: Cost-utility; cost; dialysis; economics; kidney failure; peritoneal dialysis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
The 10-year model predicted survival versus observed survival for hemodialysis (HD) and peritoneal dialysis (PD) starters. Abbreviation: CORR, Canadian Organ Replacement Register.
Figure 2
Figure 2
Univariate sensitivity analysis: lifetime cost for all dialysis patients. Abbreviations: CAPD, continuous ambulatory peritoneal dialysis; CCPD, continuous cycling peritoneal dialysis; CV, cardiovascular; HD, hemodialysis.
Figure 3
Figure 3
Probabilistic sensitivity analysis: costs and quality-adjusted life-years (QALYs) for all dialysis patients.
See this image and copyright information in PMC

References

    1. Canadian Institute for Health Information Canadian Organ Replacement Register Annual Report: Treatment of End-Stage Organ Failure in Canada, 2004 to 2013. https://secure.cihi.ca/free_products/2015_CORR_AnnualReport_ENweb.pdf Accessed March 12, 2020.
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    1. Beaudry A., Ferguson T.W., Rigatto C., Tangri N., Dumanski S., Komenda P. Cost of dialysis therapy by modality in Manitoba. Clin J Am Soc Nephrol. 2018;13(8):1197–1203. - PMC - PubMed

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