TY - JOUR
T1 - Cost-effectiveness of initiating dialysis early
T2 - A randomized controlled trial
AU - Harris, Anthony
AU - Cooper, Bruce A.
AU - Li, Jingjing
AU - Bulfone, Liliana
AU - Branley, Pauline
AU - Collins, John F.
AU - Craig, Jonathan C.
AU - Fraenkel, Margaret B.
AU - Johnson, David W.
AU - Kesselhut, Joan
AU - Luxton, Grant
AU - Pilmore, Andrew
AU - Rosevear, Martin
AU - Tiller, David J.
AU - Pollock, Carol A.
AU - Harris, David C.H.
PY - 2011/5
Y1 - 2011/5
N2 - 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.
AB - 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.
KW - dialysis therapy
KW - chronic kidney disease (CKD)
KW - dialysis
KW - cost-effectiveness
KW - cost
KW - Chronic kidney disease
KW - economic evaluation
KW - quality of life
KW - randomized
UR - http://www.scopus.com/inward/record.url?scp=79954525737&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2010.12.018
DO - 10.1053/j.ajkd.2010.12.018
M3 - Article
VL - 57
SP - 707
EP - 715
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 5
ER -