Department of Nephrology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Nephrol Dial Transplant. 2013 Jul;28(7):1865-73. doi: 10.1093/ndt/gft045. Epub 2013 Jun 13.
Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD).
A cost-utility analysis was performed using a Markov model. It included data from the Convective Transport Study (CONTRAST), a randomized controlled trial that compared online HDF with low-flux HD. Costs were estimated using a societal perspective. Probabilistic sensitivity analyses were performed to study uncertainty.
Total annual costs for HDF and HD were €88 622±19,272 and €86,086±15,945, respectively (in 2009 euros). When modelled over a 5-year period, the incremental cost per quality-adjusted life year (QALY) of HDF versus HD was €287,679. Sensitivity analyses revealed that this amount will not fall below €140,000, even under the most favourable assumptions like a high-convection volume (>20.3 L).
Based on accepted societal willingness-to-pay thresholds, HDF cannot be considered a cost-effective treatment for patients with end-stage renal disease at present. Apparently, minor additional costs of HDF are not counterbalanced by a relevant QALY gain.
尽管人们对血液透析滤过（HDF）越来越感兴趣，但目前仍缺乏关于这种透析方式的成本和成本效益的信息。因此，我们的目的是研究 HDF 与血液透析（HD）的成本效益。
使用马尔可夫模型进行成本效益分析。该模型纳入了来自 CONvective TRAnsPort Study（CONTRAST）的研究数据，该随机对照试验比较了在线 HDF 与低通量 HD。使用社会视角估计成本。进行概率敏感性分析以研究不确定性。
HDF 和 HD 的总年度成本分别为 88622 欧元±19272 欧元和 86086 欧元±15945 欧元（2009 年欧元）。在 5 年期间建模时，HDF 相对于 HD 的每增加一个质量调整生命年（QALY）的增量成本为 287679 欧元。敏感性分析表明，即使在最有利的假设下，如高对流量（>20.3 L），这一数额也不会低于 140000 欧元。
根据社会可接受的支付意愿阈值，目前 HDF 不能被视为终末期肾病患者的一种具有成本效益的治疗方法。显然，HDF 的少量额外成本并没有被相应的 QALY 收益所抵消。
