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, vol. 57, no. 5, pp. 707-715, doi: 10.1053/j.ajkd.2010.12.018.

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Title Cost-effectiveness of initiating dialysis early: a randomized controlled trial
Author(s) Harris, Anthony
Cooper, Bruce A.
Li, Jing Jing
Bulfone, LilianaORCID iD for 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.
Journal name American journal of kidney diseases
Volume number 57
Issue number 5
Start page 707
End page 715
Total pages 9
Publisher Elsevier
Place of publication Maryland Heights, Mo.
Publication date 2011-05
ISSN 0272-6386
Keyword(s) chronic kidney disease
economic evaluation
quality of life
Cost-Benefit Analysis
Follow-Up Studies
Kidney Failure, Chronic
Middle Aged
Renal Dialysis
Time Factors
Treatment Outcome
Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
Summary 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 m(2) 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 m(2) (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.
Language eng
DOI 10.1053/j.ajkd.2010.12.018
Field of Research 111799 Public Health and Health Services not elsewhere classified
1103 Clinical Sciences
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2011, National Kidney Foundation
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Document type: Journal Article
Collections: Faculty of Health
School of Health and Social Development
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