The cost-utility of haemodiafiltration versus haemodialysis in the convective transport study

Background. Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). Methods. A cost-utility analysis was performed using a Markov model. It included data from the Convective Transport Study (CONTRAST), a randomized controlled trial that compared online HDF with low-flux HD. Costs were estimated using a societal perspective. Probabilistic sensitivity analyses were performed to study uncertainty. Results. Total annual costs for HDF and HD were €88 622 ± 19 272 and €86 086 ± 15 945, respectively (in 2009 euros). When modelled over a 5-year period, the incremental cost per quality-adjusted life year (QALY) of HDF versus HD was €287 679. Sensitivity analyses revealed that this amount will not fall below €140 000, even under the most favourable assumptions like a high-convection volume (>20.3 L). Conclusions. Based on accepted societal willingness-to-pay thresholds, HDF cannot be considered a cost-effective treatment for patients with end-stage renal disease at present. Apparently, minor additional costs of HDF are not counterbalanced by a relevant QALY gain.

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