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  • Review Article
  • Published:

Economic evaluation of dialysis therapies

Key Points

  • Evidence indicates that peritoneal dialysis (PD) is the most economically efficient dialysis modality, but is underused in many settings

  • Home haemodialysis (HD) might offer compelling advantages over in-centre HD, although these benefits may only be realized if patients move from in-centre to home HD

  • In developing nations, PD is generally similar or less costly than other dialysis modalities, and might become more attractive if optimized, for example, through local manufacturing of materials used in the procedure

  • Provision of dialysis therapy might not be the best use of the finite health-care resources available to low-income nations

  • Policies and incentives should be aligned with the economic efficiencies of dialysis to ensure sustainability of both the care of patients with end-stage renal disease and the health-care system overall

Abstract

The prevalence of chronic kidney disease and end-stage renal disease requiring dialysis therapy continues to increase worldwide, and despite technological advances, treatment remains resource intensive. Thus, the increasing burden of dialysis therapy on finite health-care budgets is an important consideration. The principles of allocative efficiency and the concept of 'opportunity cost' can be used to assess whether dialysis is economically justified; if dialysis is to be provided, cost-minimization and cost–utility analyses can be used to identify the most efficient dialysis modality. Existing studies have examined the cost, and where relevant the effectiveness, of the various currently available peritoneal dialysis and haemodialysis modalities. In this Review, we discuss variations in the intrinsic costs of the available dialysis modalities as well as other factors, such as variation by country, available health-care infrastructures, the timing of dialysis initiation and renal transplantation. We draw on data from robust micro-costing studies of the various dialysis modalities in Canada to highlight key issues.

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Figure 1: Annual health-care costs of dialysis stratified by modality in Canada.
Figure 2: National variations in HD:PD cost ratios in 46 countries worldwide.31

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Acknowledgements

S.W.K., M.T. and B.J.M. have received career salary awards from the Alberta Heritage Foundation for Medical Research/Alberta Innovates Health Solutions. The work of S.W.K., M.T., B.C. and B.J.M. is supported by a joint initiative between Alberta Health and Wellness and the Universities of Alberta and Calgary. The work of M.T. is also supported by a Government of Canada Research Chair focused on the optimal care of people with chronic kidney disease.

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S.W.K. and M.T. made substantial contributions to discussion of content, S.W.K. researched the data and wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Scott W. Klarenbach.

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Klarenbach, S., Tonelli, M., Chui, B. et al. Economic evaluation of dialysis therapies. Nat Rev Nephrol 10, 644–652 (2014). https://doi.org/10.1038/nrneph.2014.145

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