Cost effectiveness of initiating dialysis early: A randomized controlled trial

Harris, Anthony, Cooper, Bruce A., Li, Jing Jing, 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. and Harris, David C. (2011) Cost effectiveness of initiating dialysis early: A randomized controlled trial. American Journal of Kidney Diseases, 57 5: 507-515. doi:10.1053/j.ajkd.2010.12.018


Author Harris, Anthony
Cooper, Bruce A.
Li, Jing Jing
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.
Title Cost effectiveness of initiating dialysis early: A randomized controlled trial
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
Publication date 2011-05
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2010.12.018
Volume 57
Issue 5
Start page 507
End page 515
Total pages 9
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2012
Language eng
Formatted 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. © 2011 National Kidney Foundation, Inc.
Keyword Chronic kidney disease
Cost
Cost-effectiveness
Dialysis
Economic evaluation
Quality of life
Randomized
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 23 February 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Wed, 23 Mar 2011, 15:17:56 EST by Debbie Banks on behalf of School of Medicine