A health economic evaluation of the multinational, randomized controlled CONVINCE trial: cost-utility of high-dose online hemodiafiltration compared to high-flux hemodialysis

Aniek E M Schouten¹, Felix Fischer², Peter J Blankestijn³, Robin W M Vernooij⁴, Carinna Hockham⁵, Giovanni F M Strippoli⁶, Bernard Canaud⁷, Jörgen Hegbrant⁸, Claudia Barth⁹, Krister Cromm¹⁰, Andrew Davenport¹¹, Kathrin I Fischer¹², Matthias Rose¹³, Mariëtta Török¹⁴, Mark Woodward¹⁵, Michiel L Bots¹⁶, G Ardine de Wit¹⁷, Geert W J Frederix¹⁶, Miriam P van der Meulen¹⁶; CONVINCE Scientific Committee

Collaborators, Affiliations

Collaborators

CONVINCE Scientific Committee:
P J Blankestijn, R W M Vernooij, C Hockham, G F M Strippoli, B Canaud, J Hegbrant, C Barth, K Cromm, A Davenport, M Rose, M Török, M Woodward, M L Bots

Affiliations

¹ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: a.e.m.schouten-10@umcutrecht.nl.
² Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
³ Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁵ George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
⁶ Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy; School of Public Health, University of Sydney, Sydney, Australia.
⁷ Montpellier University School of Medicine, Montpellier, France; Fresenius Medical Care Deutschland, Global Medical Office, Bad Homburg, Germany.
⁸ Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁹ Medical Scientific Affairs, B. Braun Avitum, Melsungen, Germany.
¹⁰ Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Fresenius Medical Care Deutschland, Global Medical Office, Bad Homburg, Germany.
¹¹ Division of Medicine, Department of Renal Medicine, Royal Free Hospital London, University College London, London, UK.
¹² Department of Psychosomatic Medicine, Centre of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
¹³ Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Centre of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
¹⁴ Diaverum Dialysis Centers, Diaverum Hungary Kft, Budapest, Hungary.
¹⁵ George Institute for Global Health, School of Public Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹⁶ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁷ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Centre for Public Health, Healthcare and Society, National Institute of Public Health and the Environment, Bilthoven, the Netherlands; Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

PMID: 39848405
DOI: 10.1016/j.kint.2024.12.018

Randomized Controlled Trial

A health economic evaluation of the multinational, randomized controlled CONVINCE trial: cost-utility of high-dose online hemodiafiltration compared to high-flux hemodialysis

Aniek E M Schouten et al. Kidney Int. 2025 Apr.

. 2025 Apr;107(4):728-739.

doi: 10.1016/j.kint.2024.12.018. Epub 2025 Jan 22.

Authors

Collaborators

CONVINCE Scientific Committee:
P J Blankestijn, R W M Vernooij, C Hockham, G F M Strippoli, B Canaud, J Hegbrant, C Barth, K Cromm, A Davenport, M Rose, M Török, M Woodward, M L Bots

Affiliations

¹ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: a.e.m.schouten-10@umcutrecht.nl.
² Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
³ Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁵ George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
⁶ Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy; School of Public Health, University of Sydney, Sydney, Australia.
⁷ Montpellier University School of Medicine, Montpellier, France; Fresenius Medical Care Deutschland, Global Medical Office, Bad Homburg, Germany.
⁸ Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁹ Medical Scientific Affairs, B. Braun Avitum, Melsungen, Germany.
¹⁰ Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Fresenius Medical Care Deutschland, Global Medical Office, Bad Homburg, Germany.
¹¹ Division of Medicine, Department of Renal Medicine, Royal Free Hospital London, University College London, London, UK.
¹² Department of Psychosomatic Medicine, Centre of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
¹³ Center for Patient-Centered Outcomes Research, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Centre of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
¹⁴ Diaverum Dialysis Centers, Diaverum Hungary Kft, Budapest, Hungary.
¹⁵ George Institute for Global Health, School of Public Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹⁶ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁷ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Centre for Public Health, Healthcare and Society, National Institute of Public Health and the Environment, Bilthoven, the Netherlands; Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

PMID: 39848405
DOI: 10.1016/j.kint.2024.12.018

Abstract

High-flux hemodialysis (HD) and high-dose hemodiafiltration (HDF) are established treatments for patients with kidney failure. Since HDF has been associated with improved survival rates compared to HD, we evaluated the cost-effectiveness of HDF compared to HD. Cost-utility analyses were performed from a societal perspective alongside the multinational randomized controlled CONVINCE trial. A Markov cohort model was used to extrapolate results to a lifetime time horizon. Costs of dialysis sessions were based on published data, with two scenarios reflecting different estimates for costs of dialysis staff. Other healthcare resource use, productivity losses and quality of life were collected in the electronic case report form or by country-adapted, self-reported questionnaires. Scenario and probabilistic sensitivity analyses were performed. In the two-year trial-based analysis, HDF was associated with higher quality-adjusted life years (QALYs) and higher costs, with incremental costs per QALY (ICER) of €31,898 and €37,344, depending on dialysis staff costs. The lifetime Markov cohort model resulted in ICERs of €27,068 and €36,751. Compared to HD, HDF resulted in an additional year in perfect health at increased costs. Sensitivity analyses of the lifetime analyses showed the probability of cost-effectiveness was more than 90% at willingness-to-pay threshold of €50,000/QALY. The ICER was €13,231 when excluding all costs in additional life years. The probability of cost-effectiveness was mainly driven by costs due to additional dialysis sessions in life years gained, and not due to additional costs per dialysis session. As costs may differ between countries and centers, we recommend translating our results to local settings.

Keywords: cost utility; cost-effectiveness; hemodiafiltration; hemodialysis; kidney failure; multinational trial.

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A health economic evaluation of the multinational, randomized controlled CONVINCE trial: cost-utility of high-dose online hemodiafiltration compared to high-flux hemodialysis

Collaborators

Affiliations

A health economic evaluation of the multinational, randomized controlled CONVINCE trial: cost-utility of high-dose online hemodiafiltration compared to high-flux hemodialysis

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Medical

Research Materials