The cost-effectiveness of increasing kidney transplantation and home-based dialysis
Article first published online: 2 FEB 2009
© 2009 The Authors. Journal compilation © 2009 Asian Pacific Society of Nephrology
Special Issue: Includes Special Issue on ANCA-associated Vasculitis
Volume 14, Issue 1, pages 123–132, February 2009
How to Cite
HOWARD, K., SALKELD, G., WHITE, S., MCDONALD, S., CHADBAN, S., CRAIG, J. C. and CASS, A. (2009), The cost-effectiveness of increasing kidney transplantation and home-based dialysis. Nephrology, 14: 123–132. doi: 10.1111/j.1440-1797.2008.01073.x
- Issue published online: 31 MAR 2009
- Article first published online: 2 FEB 2009
- Accepted for publication 30 September 2008.
- cost-effectiveness analysis;
- cost utility analysis;
- decision analysis;
- kidney transplantation
Background: Renal replacement therapy (RRT) consumes sizable proportions of health budgets internationally, but there is considerable variability in choice of RRT modality among and within countries with major implications for health outcomes and costs. We aimed to quantify these implications for increasing kidney transplantation and improving the rate of home-based dialysis.
Methods: A multiple cohort Markov model was used to assess costs and health outcomes of RRT for new end-stage kidney disease (ESKD) patients in Australia for 2005–2010, using a health-care funder perspective. Patient characteristics and current practice patterns were based on the ANZDATA Registry. Two proposed changes were modelled: (i) increasing kidney transplants by between 10% and 50% by 2010; and (ii) increasing home haemodialysis (HD) and peritoneal dialysis (PD) to the highest rates observed among Australian centres. We assessed costs (Australian dollars), survival and quality-adjusted survival, and cost-effectiveness.
Results: The number of new ESKD patients in 2010 was estimated to be 2700, with annual RRT costs of about $A700 million; cumulative costs (2005–2010) were $A5 billion. Increasing transplants by 10–50% saves between $A5.8 and $A26.2 million, and increases quality-adjusted life years (QALYs) by 130–658 QALYs. Switching new patients from hospital HD to (i) home HD saves $A46.6 million by 2010; or (ii) PD saves $A122.1 million.
Conclusions: These clinical practice changes reduce costs, improve patient quality of life and, in the case of transplantation, increase survival. Planning for RRT services should incorporate efforts to maximize rates of transplantation and to encourage home-based over hospital-based dialysis to optimize cost-effectiveness in RRT service delivery.