Limits...
Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

View Article: PubMed Central - PubMed

ABSTRACT

Background: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.

Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed.

Results: An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients.

Conclusion: HDF can be considered cost-effective compared to HF-HD.

No MeSH data available.


Related in: MedlinePlus

Structure of the Markov model.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis; HRQoL, health-related quality of life.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5036827&req=5

f1-ceor-8-531: Structure of the Markov model.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis; HRQoL, health-related quality of life.

Mentions: The analysis comprised a simulation13–15 based on results from combined previous observational studies, randomized clinical trials, and a meta-analysis with the following steps: 1) estimation of a) the survival function of HF-HD patients from the Membrane Permeability Outcome Study16 dataset and b) estimation of the survival function of HDF patients using the risk reduction estimates due to the treatment effect from the meta-analysis of Mostovaya et al17 (even though it includes also studies comparing HDF to low-flux HD, it was considered the best proxy with respect to other alternative meta-analyses available in the literature); 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; 3) application of state-specific HRQoL coefficients and differential costs (materials, testing, and consumption of water) derived from the literature. In addition, in a secondary subgroup analysis we considered the ESHOL5 estimations related to diabetics and nondiabetics. This was done because among all the studies considered the ESHOL study provides results related to these particular subgroups of patients. Two mirror-image Markov models (Figure 1) were developed with the aim to generate a simulation comparing the survival of the same sample of patients treated with HF-HD and HDF. Three possible states were considered: alive and under therapy, dead due to the disease under therapy, and dead for other cause (ie, considering the overall mortality, based on age- and sex-adjusted life tables).


Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis
Structure of the Markov model.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis; HRQoL, health-related quality of life.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036827&req=5

f1-ceor-8-531: Structure of the Markov model.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis; HRQoL, health-related quality of life.
Mentions: The analysis comprised a simulation13–15 based on results from combined previous observational studies, randomized clinical trials, and a meta-analysis with the following steps: 1) estimation of a) the survival function of HF-HD patients from the Membrane Permeability Outcome Study16 dataset and b) estimation of the survival function of HDF patients using the risk reduction estimates due to the treatment effect from the meta-analysis of Mostovaya et al17 (even though it includes also studies comparing HDF to low-flux HD, it was considered the best proxy with respect to other alternative meta-analyses available in the literature); 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; 3) application of state-specific HRQoL coefficients and differential costs (materials, testing, and consumption of water) derived from the literature. In addition, in a secondary subgroup analysis we considered the ESHOL5 estimations related to diabetics and nondiabetics. This was done because among all the studies considered the ESHOL study provides results related to these particular subgroups of patients. Two mirror-image Markov models (Figure 1) were developed with the aim to generate a simulation comparing the survival of the same sample of patients treated with HF-HD and HDF. Three possible states were considered: alive and under therapy, dead due to the disease under therapy, and dead for other cause (ie, considering the overall mortality, based on age- and sex-adjusted life tables).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.

Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different risk profiles, for example, by age (patients aged 40, 50, and 60 years), sex, and diabetic status. Scatter plots of simulations in the cost-effectiveness plane were produced, incremental cost-effectiveness ratios were estimated, and cost-effectiveness acceptability curves were computed.

Results: An incremental cost-effectiveness ratio of €6,982/quality-adjusted life years (QALY) was estimated for the baseline cohort of 50-year-old male patients. Given the commonly accepted threshold of €40,000/QALY, HDF is cost-effective. The probabilistic sensitivity analysis showed that HDF is cost-effective with a probability of ~81% at a threshold of €40,000/QALY. It is fundamental to measure the outcome also in terms of quality of life. HDF is more cost-effective for younger patients.

Conclusion: HDF can be considered cost-effective compared to HF-HD.

No MeSH data available.


Related in: MedlinePlus