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

Overview

Journal Kidney Med

Specialty Nephrology

Date 2021 Feb 19

PMID 33604537

Citations 19

Authors

Thomas W Ferguson

Reid H Whitlock

Ryan J Bamforth

Alain Beaudry

Joseph Darcel

Michelle Di Nella

Claudio Rigatto

Navdeep Tangri

Paul Komenda

Affiliations

Soon will be listed here.

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.

Citing Articles

Home Sweet Home: A Program Report on Promoting the Uptake of Home Dialysis.

Churchill L, Reintjes F, Pauly R, Shah N, Thompson S Can J Kidney Health Dis. 2025; 12():20543581241312625.

PMID: 39802878 PMC: 11724405. DOI: 10.1177/20543581241312625.

Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA.

Nkunu V, Tungsanga S, Diongole H, Sarki A, Arruebo S, Caskey F PLOS Glob Public Health. 2024; 4(12):e0003979.

PMID: 39621612 PMC: 11611141. DOI: 10.1371/journal.pgph.0003979.

A Cost Analysis of Catheter Ablation for Atrial Fibrillation: A Canadian Pre-Post Study.

Bolous Y, Koto P, Sapp J, Gray C, Lee D, Berbenetz N CJC Open. 2024; 6(11):1372-1378.

PMID: 39582704 PMC: 11583884. DOI: 10.1016/j.cjco.2024.07.016.

Role of SGLT-2 Inhibitors in Ultrafiltration Failure in Peritoneal Dialysis: A Narrative Review.

Riedl Khursigara M, Liu P, Kaur R, Mavrakanas T Can J Kidney Health Dis. 2024; 11:20543581241293500.

PMID: 39502166 PMC: 11536389. DOI: 10.1177/20543581241293500.

Navigating the Global Economic Landscape of Dialysis: A Summary of Expert Opinions from The 4th International Congress of Chinese Nephrologists.

Kam-Tao Li P, Ng J, Cai G, Chen W, Chow K, Fan S Kidney Dis (Basel). 2024; 10(5):384-397.

PMID: 39430291 PMC: 11488833. DOI: 10.1159/000540152.

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