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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.


Cost-effectiveness acceptability curves for male patients aged 50 years old treated with high-flux HD or online HDF.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis.
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f3-ceor-8-531: Cost-effectiveness acceptability curves for male patients aged 50 years old treated with high-flux HD or online HDF.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis.

Mentions: The results of the 1,000 Monte Carlo simulations for the cohort of 50-year-old male patients are shown in the cost-effectiveness scatter plot in Figure 2. From the mean values of all the simulations in this specific cohort of patients, the ICER was €6,982/QALY. On the basis of these simulations it was possible to derive the probability of cost-effectiveness given different thresholds, as shown in Figure 3. The CEAC corresponding to HDF starts from 0, meaning that there is no possibility that this alternative therapy is cost-saving. The threshold must be at least €2,000 per QALY to have a probability of cost-effectiveness >0. The probability of cost-effectiveness increased to 50% with a threshold of €7,000/QALY, to 70% with a threshold of €15,000/QALY and to 81% with the commonly accepted threshold of €40,000/QALY. The probability of cost-effectiveness always stayed below 84% for a threshold of over €40,000/QALY. This asymptotic value results from the fact that a fraction of the simulations represent cases where the alternative therapy (HDF) causes higher costs and provided fewer benefits. This means that even with any budget constraint, there is some probability that the alternative therapy is not cost-effective and the traditional one (HF-HD) is preferred.


Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis
Cost-effectiveness acceptability curves for male patients aged 50 years old treated with high-flux HD or online HDF.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis.
© Copyright Policy
Related In: Results  -  Collection

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

f3-ceor-8-531: Cost-effectiveness acceptability curves for male patients aged 50 years old treated with high-flux HD or online HDF.Abbreviations: HDF, hemodiafiltration; HF-HD, high-flux hemodialysis.
Mentions: The results of the 1,000 Monte Carlo simulations for the cohort of 50-year-old male patients are shown in the cost-effectiveness scatter plot in Figure 2. From the mean values of all the simulations in this specific cohort of patients, the ICER was €6,982/QALY. On the basis of these simulations it was possible to derive the probability of cost-effectiveness given different thresholds, as shown in Figure 3. The CEAC corresponding to HDF starts from 0, meaning that there is no possibility that this alternative therapy is cost-saving. The threshold must be at least €2,000 per QALY to have a probability of cost-effectiveness >0. The probability of cost-effectiveness increased to 50% with a threshold of €7,000/QALY, to 70% with a threshold of €15,000/QALY and to 81% with the commonly accepted threshold of €40,000/QALY. The probability of cost-effectiveness always stayed below 84% for a threshold of over €40,000/QALY. This asymptotic value results from the fact that a fraction of the simulations represent cases where the alternative therapy (HDF) causes higher costs and provided fewer benefits. This means that even with any budget constraint, there is some probability that the alternative therapy is not cost-effective and the traditional one (HF-HD) is preferred.

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.