Cost-effectiveness analysis of renal replacement therapy in Austria

Background. Providing renal replacement therapy (RRT) for end-stage renal disease patients is resource intensive. Despite growing financial pressure in health care systems worldwide, cost-effectiveness studies of RRT modalities are scarce. Methods. We developed a Markov model of costs, quality of life and survival to compare three different assignment strategies to chronic RRT in Europe. Results. Mean annual treatment costs for haemodialysis were (sic)43 600 during the first 12 months, (sic)40 000 between 13 and 24 months and (sic)40 600 beyond 25 months after initiation of treatment. Mean annual treatment costs for peritoneal dialysis were (sic)25 900 during the first 12 months, (sic)15 300 between 13 and 24 months and (sic)20 500 beyond 25 months. Mean annual therapy costs for a kidney transplantation during the first 12 months were (sic)50 900 from a living donor, (sic)51 000 from a deceased donor, (sic)17 200 between 13 and 24 months and (sic)12 900 beyond 25 months after engraftment. Over the next 10 years in Austria with a population of 8 million people, increased assignment to peritoneal dialysis of 20% incident patients saved (sic)26 million with a discount rate of 3% and gained 839 quality-adjusted life years (QALYs); additionally, increasing renal transplants to 10% from live donations saved (sic)38 million discounted and gained 2242 QALYs. Conclusions. Live donor renal transplantation is cost effective and associated with increase in QALYs. Therefore, preemptive live kidney transplantation should be promoted from a fiscal as well as medical point of (sic)iew.