Cost-effectiveness of initiating dialysis early:  A randomized controlled trial

Anthony Harris; Bruce A. Cooper; Jingjing Li; Liliana Bulfone; Pauline Branley; John F. Collins; Jonathan C. Craig; Margaret B. Fraenkel; David W. Johnson; Joan Kesselhut; Grant Luxton; Andrew Pilmore; Martin Rosevear; David J. Tiller; Carol A. Pollock; David C.H. Harris

doi:10.1053/j.ajkd.2010.12.018

Cost-effectiveness of initiating dialysis early: A randomized controlled trial

Anthony Harris, Bruce A. Cooper, Jingjing Li, Liliana Bulfone, Pauline Branley, John F. Collins, Jonathan C. Craig, Margaret B. Fraenkel, David W. Johnson, Joan Kesselhut, Grant Luxton, Andrew Pilmore, Martin Rosevear, David J. Tiller, Carol A. Pollock, David C.H. Harris

Research output: Contribution to journal › Article

78 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	707-715
Number of pages	9
Journal	American Journal of Kidney Diseases
Volume	57
Issue number	5
DOIs	https://doi.org/10.1053/j.ajkd.2010.12.018
Publication status	Published - 23 Feb 2011
Externally published	Yes

Keywords

dialysis therapy
chronic kidney disease (CKD)

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Harris, A., Cooper, B. A., Li, J., Bulfone, L., Branley, P., Collins, J. F., Craig, J. C., Fraenkel, M. B., Johnson, D. W., Kesselhut, J., Luxton, G., Pilmore, A., Rosevear, M., Tiller, D. J., Pollock, C. A., & Harris, D. C. H. (2011). Cost-effectiveness of initiating dialysis early: A randomized controlled trial. American Journal of Kidney Diseases, 57(5), 707-715. https://doi.org/10.1053/j.ajkd.2010.12.018

Harris, Anthony ; Cooper, Bruce A. ; Li, Jingjing ; Bulfone, Liliana ; Branley, Pauline ; Collins, John F. ; Craig, Jonathan C. ; Fraenkel, Margaret B. ; Johnson, David W. ; Kesselhut, Joan ; Luxton, Grant ; Pilmore, Andrew ; Rosevear, Martin ; Tiller, David J. ; Pollock, Carol A. ; Harris, David C.H. / Cost-effectiveness of initiating dialysis early : A randomized controlled trial. In: American Journal of Kidney Diseases. 2011 ; Vol. 57, No. 5. pp. 707-715.

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title = "Cost-effectiveness of initiating dialysis early: A randomized controlled trial",

abstract = "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.",

keywords = "dialysis therapy, chronic kidney disease (CKD)",

author = "Anthony Harris and Cooper, {Bruce A.} and Jingjing Li and Liliana Bulfone and Pauline Branley and Collins, {John F.} and Craig, {Jonathan C.} and Fraenkel, {Margaret B.} and Johnson, {David W.} and Joan Kesselhut and Grant Luxton and Andrew Pilmore and Martin Rosevear and Tiller, {David J.} and Pollock, {Carol A.} and Harris, {David C.H.}",

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language = "English",

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Harris, A, Cooper, BA, Li, J, Bulfone, L, Branley, P, Collins, JF, Craig, JC, Fraenkel, MB, Johnson, DW, Kesselhut, J, Luxton, G, Pilmore, A, Rosevear, M, Tiller, DJ, Pollock, CA & Harris, DCH 2011, 'Cost-effectiveness of initiating dialysis early: A randomized controlled trial', American Journal of Kidney Diseases, vol. 57, no. 5, pp. 707-715. https://doi.org/10.1053/j.ajkd.2010.12.018

Cost-effectiveness of initiating dialysis early : A randomized controlled trial. / Harris, Anthony; Cooper, Bruce A.; Li, Jingjing; Bulfone, Liliana; Branley, Pauline; Collins, John F.; Craig, Jonathan C.; Fraenkel, Margaret B.; Johnson, David W.; Kesselhut, Joan; Luxton, Grant; Pilmore, Andrew; Rosevear, Martin; Tiller, David J.; Pollock, Carol A.; Harris, David C.H.

In: American Journal of Kidney Diseases, Vol. 57, No. 5, 23.02.2011, p. 707-715.

Research output: Contribution to journal › Article

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 - 2011/2/23

Y1 - 2011/2/23

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)

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 -