The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations
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SYSTEMATIC REVIEW
The Cost‑Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations Fei Yang1 · Meixia Liao2 · Pusheng Wang1 · Zheng Yang2 · Yongguang Liu3 Accepted: 30 September 2020 © The Author(s) 2020
Abstract Background Kidney replacement therapy (KRT) is a lifesaving but costly treatment for patients with end-stage kidney disease (ESKD). The objective of this study was to review full economic evaluations comparing KRT modalities specified as hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) for patients with ESKD. Methods We conducted a systematic review of the literature from PubMed, Embase, EconLit (EBSCO), Web of Science, Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effects (DARE), and CRD Health Technology Assessment Database from inception until 5 January 2020. Full economic evaluations were included if they compared three forms of KRT specified as PD, HD, and KT. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Ten studies were identified in the review. The majority of the studies were model-based evaluations and included a cost-utility analysis. Four studies were conducted from a public healthcare perspective, three from a societal perspective, and three from a third-party payer perspective. None of the studies adequately addressed all the applicable items of the CHEERS checklist. The most infrequently reported items were characterizing heterogeneity, target population, and characterizing uncertainty. There is a lack of studies that conduct from a societal perspective and take into account characterizing heterogeneity. All included studies indicate that KT is the most cost-effective KRT modality, with either a dominant position over HD and PD or an incremental cost-effectiveness ratio well below the accepted willingness-to-pay threshold. The majority of studies suggest that PD is less costly and offers comparable or better health outcomes than HD. Conclusions Our systematic review suggests that KT is the most cost-effective KRT modality, but there is no firm conclusion about the cost-effectiveness of HD and PD. Further economic evaluations can be conducted from a societal perspective and detail the evidence for subsets of patients with different characteristics.
Fei Yang and Meixia Liao are co-first authors.
Key Points for Decision Makers
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00614-4) contains supplementary material, which is available to authorized users.
Kidney transplantation is the most cost-effective kidney replacement therapy modality, but there is no firm conclusion about the cost-effectiveness of hemodialysis and peritoneal dialysis.
* Yongguang Liu [email protected] 1
Tsinghua Shenzhen International Graduate School,
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