An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy

Objectives: To estimate lifelong costs and quality adjusted life years (QALYs) of hemodialysis (HID), peritoneal dialysis (PD) and renal transplantation (Tx) in Greece, based on individual patient life expectancy. Methods: A nationally representative patient sample on each modality, HD: N=642, PD: N=65 and Tx: N= 167, was self-administered the SF-36 Health Survey, from which the preference-based SF-6D utility index was derived. Lifelong QALYs were estimated from literature-based expected remaining life years according to age, gender and modality. Cost analyses were performed from the perspective of the health system. Costs and QALYs were discounted at 5% and sensitivity analyses were performed. Results: Estimated lifelong QALYs were 4.37 (1113), 3.94 (PD) and 16.11 (Tx) (P < 0.001). Annual HD and PD costs per patient were estimated at (sic)36,247 and (sic)30,719 respectively. For Tx, average I st year, 3-year and lifelong (undiscounted) costs were (sic)3 1,714, (sic)43,275 and (sic)151,274 respectively. Cost per QALY was higher in HD ((sic)60,353) compared to PD ((sic)54,504) and I st year Tx ((sic)45,523). Conclusions: HD is used by 75% of the Greek ESRD patients, hence cost-saving efforts must be intensified. Reconsidering supply and reimbursement policies for dialyzers and drugs, establishing satellite dialysis units and adopting telemedicine in remote areas could be explored. Wider use of PD is also in the direction of increasing cost-effectiveness. Finally, efforts are required for disseminating the idea of organ donation. (C) 2007 Elsevier Ireland Ltd. All rights reserved.