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 V43 600 during the first 12 months, V40 000 between 13 and 24 months and V40 600 beyond 25 months after initiation of treatment. Mean annual treatment costs for peritoneal dialysis were V25 900 during the first 12 months, V15 300 between 13 and 24 months and V20 500 beyond 25 months. Mean annual therapy costs for a kidney transplantation during the first 12 months were V50 900 from a living donor, V51 000 from a deceased donor, V17 200 between 13 and 24 months and V12 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 V26 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 V38 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 view.