Cost-Effectiveness of Initiating Dialysis Early: A Randomized Controlled Trial

• Published in: American journal of kidney diseases Vol. 57; no. 5; pp. 707 - 715
• Main Authors: Harris, Anthony, MA, MSc, Cooper, Bruce A., MBBS, MM(ClinEpi), PhD, FRACP, Li, Jing Jing, BPharm, BCom, Bulfone, Liliana, BPharm, MBA, GradCertHealthEco, Branley, Pauline, BMed, PhD, FRACP, Collins, John F., MBChB, Craig, Jonathan C., MBChB, DCH, MM (ClinEpi), PhD, Fraenkel, Margaret B., BM, BS, PhD, FRACP, Johnson, David W., MBBS, PhD, FRACP, PhD, Kesselhut, Joan, RN, Luxton, Grant, MBBS, FRACP, Pilmore, Andrew, BSc, DipSc, Rosevear, Martin, BA, BSc, Tiller, David J., AO, MBBS, FRACP, Pollock, Carol A., MBBS, PhD, FRACP, Harris, David C., MD, BS, FRACP
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2011; Elsevier
• Subjects: Aged; Biological and medical sciences; Chronic kidney disease; cost; Cost-Benefit Analysis; cost-effectiveness; dialysis; economic evaluation; Female; Follow-Up Studies; Humans; Kidney Failure, Chronic - economics; Kidney Failure, Chronic - therapy; Kidneys; Male; Medical sciences; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; quality of life; randomized; Renal Dialysis - economics; Renal Dialysis - methods; Renal failure; Time Factors; Treatment Outcome; Urinary system involvement in other diseases. Miscellaneous; dialysis; cost-effectiveness; cost; Chronic kidney disease; economic evaluation; quality of life; randomized; Kidney disease; Costs; Nephrology; Urinary system disease; Randomized controlled trial; Urology; Quality of life; Randomization; Health economy; Renal failure; Early; Dialysis; Economic aspect; Cost efficiency analysis
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2010.12.018

Background Planned early initiation of dialysis therapy based on estimated kidney function does not influence mortality and major comorbid conditions, but amelioration of symptoms may improve quality of life and decrease costs. Study Design Patients with progressive chronic kidney disease and a Cockcroft-Gault estimated glomerular filtration rate of 10-15 mL/min/1.73 m2 were randomly assigned to start dialysis therapy at a glomerular filtration rate of either 10-14 (early start) or 5-7 mL/min/1.73 m2 (late start). Setting & Population Of the original 828 patients in the IDEAL (Initiation of Dialysis Early or Late) Trial in renal units in Australia and New Zealand, 642 agreed to participate in this cost-effectiveness study. Study Perspective & Timeframe A societal perspective was taken for costs. Patients were enrolled between July 1, 2000, and November 14, 2008, and followed up until November 14, 2009. Intervention Planned earlier start of maintenance dialysis therapy. Outcomes Difference in quality of life and costs. Results Median follow-up of patients (307 early start, 335 late start) was 4.15 years, with a 6-month difference in median duration of dialysis therapy. Mean direct dialysis costs were significantly higher in the early-start group ($10,777; 95% CI, $313 to $22,801). Total costs, including costs for resources used to manage adverse events, were higher in the early-start group ($18,715; 95% CI, −$3,162 to $43,021), although not statistically different. Adjusted for differences in baseline quality of life, the difference in quality-adjusted survival between groups over the time horizon of the trial was not statistically different (0.02 full health equivalent years; 95% CI, −0.09 to 0.14). Limitations Missing quality-of-life questionnaires and skewed cost data, although similar in each group, decrease the precision of results. Conclusion Planned early initiation of dialysis therapy in patients with progressive chronic kidney disease has higher dialysis costs and is not associated with improved quality of life.