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. 2023 Apr;24(3):377-392.
doi: 10.1007/s10198-022-01478-2. Epub 2022 Jun 18.

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Ellen Busink  1 , Dana Kendzia  2 , Fatih Kircelli  3 , Sophie Boeger  2 , Jovana Petrovic  2 , Helen Smethurst  4 , Stephen Mitchell  4 , Christian Apel  2
Affiliations

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Ellen Busink et al. Eur J Health Econ. 2023 Apr.

Abstract

Objectives: Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients.

Methods: A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]).

Results: In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions.

Conclusions: Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.

Keywords: Economic evaluation; Healthcare policy; Patient choice; Patient pathway management; Renal replacement therapy; Systematic review.

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Conflict of interest statement

Financial interests: EB, DK, FK, SB, JP and CA are employees of Fresenius Medical Care, who funded the manuscript. SM and HS are employees of Mtech Access, an independent market access consultancy, who were commissioned by Fresenius Medical Care to develop the systematic review and manuscript.

Figures

Fig. 1
Fig. 1
Treatment algorithm for ESRD management. ESRD end-stage renal disease, HHD home haemodialysis, ICHD in-centre haemodialysis, PD peritoneal dialysis, RRT renal replacement therapy
Fig. 2
Fig. 2
PRISMA flow diagram
See this image and copyright information in PMC

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