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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 female and male patients aged 40, 50, and 60 years on hemodiafiltration (alternative cost setting).
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f6-ceor-8-531: Cost-effectiveness acceptability curves for female and male patients aged 40, 50, and 60 years on hemodiafiltration (alternative cost setting).

Mentions: Using the alternative cost setting, the model becomes fully probabilistic. Previously, cost inputs were point estimates, whereas now costs vary over the range assessed by Lebourg et al.12 The CEAC for the subgroup of 50-year-old male patients shows that 21.5% of the simulations are cost-saving (Figure 6). The probability of being cost-effective reaches 80% at the commonly accepted threshold of €40,000/QALY, and it increases only by 2.4 percentage points even with a threshold of €70,000/QALY. Results are consistent with the previous cost setting. With regard to the mean ICERs, HDF seems a little more expensive: for instance, the ICERs of the younger patients rise from €5,878/QALY and €5,732/QALY to €7,748/QALY and €7,724/QALY for female and male patients, respectively (Table 2). This subgroup analysis confirmed the previous results: the ICER increases with the age of the cohort.


Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis
Cost-effectiveness acceptability curves for female and male patients aged 40, 50, and 60 years on hemodiafiltration (alternative cost setting).
© Copyright Policy
Related In: Results  -  Collection

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

f6-ceor-8-531: Cost-effectiveness acceptability curves for female and male patients aged 40, 50, and 60 years on hemodiafiltration (alternative cost setting).
Mentions: Using the alternative cost setting, the model becomes fully probabilistic. Previously, cost inputs were point estimates, whereas now costs vary over the range assessed by Lebourg et al.12 The CEAC for the subgroup of 50-year-old male patients shows that 21.5% of the simulations are cost-saving (Figure 6). The probability of being cost-effective reaches 80% at the commonly accepted threshold of €40,000/QALY, and it increases only by 2.4 percentage points even with a threshold of €70,000/QALY. Results are consistent with the previous cost setting. With regard to the mean ICERs, HDF seems a little more expensive: for instance, the ICERs of the younger patients rise from €5,878/QALY and €5,732/QALY to €7,748/QALY and €7,724/QALY for female and male patients, respectively (Table 2). This subgroup analysis confirmed the previous results: the ICER increases with the age of the cohort.

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.