Dialysis for end-stage renal disease - Determining a cost-effective approach

Objective: Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many are as of uncertainty about which method of RRT should be chosen. This paper re ports an economic model based on a systematic review that attempts to deter mine which method of dialysis, continuous ambulatory peritoneal dialysis (C APD) or hemodialysis, a patient should have as the initial method of RRT. Methods: A systematic review and a costing exercise carried out in a Scotti sh hospital were used to populate a Markov model. Scenario analysis was use d to model plausible variations in variables included in the model. Results: In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable v ariability, ranging from between pound5,000 to pound 51,000. The higher cos ts per life-year were associated with minimum estimates of additional survi val for a patient starting RRT on hospital hemodialysis. Conclusion: It may be more cost-effective to manage patients starting on RR T with hospital hemodialysis than CAPD. This has particular implications fo r the United Kingdom, given that up to 50% of new patients receive CAPD.