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Kidney Week

Abstract: TH-PO1186

Cost Utility of High-Dose Online Hemodiafiltration Compared with High-Flux Hemodialysis: Economic Evaluation of the Multinational, Randomized Controlled CONVINCE Trial

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Schouten, Aniek E.M., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • Fischer, Felix, Charite - Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Blankestijn, Peter J., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • Vernooij, Robin W.m., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • Hockham, Carinna, Imperial College London, London, United Kingdom
  • Strippoli, Giovanni, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy
  • Canaud, Bernard J., Montpellier Universite d'Excellence, Montpellier, Occitanie, France
  • Hegbrant, Jorgen BA, Lunds Universitet, Lund, Sweden
  • Barth, Claudia Maria, B Braun Avitum AG, Melsungen, Hessen, Germany
  • Cromm, Krister, Charite - Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Davenport, Andrew, Royal Free Hospital, London, United Kingdom
  • Rose, Matthias, Charite - Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Woodward, Mark, Imperial College London, London, United Kingdom
  • Bots, Michiel L., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • de Wit, G. Ardine, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
  • Frederix, Geert, Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • van der Meulen, Miriam P, Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands

Group or Team Name

  • The CONVINCE Scientific Committee.
Background

High-flux hemodialysis (HD) and high-dose hemodiafiltration (HDF) are established treatments for patients with kidney failure. HDF has been associated with improved survival rates compared to HD. This study evaluated the cost-effectiveness of HDF compared to HD.

Methods

Cost–utility analyses were performed from a societal perspective alongside the multinational randomized controlled CONVINCE trial, with a two-year and a lifetime time-horizon using a Markov model. Costs of dialysis sessions were based on published data. Other healthcare resource use, productivity losses and quality of life were collected in the eCRF or by country-adapted, self-reported questionnaires. Scenario and probabilistic sensitivity analyses were performed.

Results

HDF was associated with higher utility values compared to HD (0.80 vs 0.78 per year alive), and higher costs (€775 difference per year alive), mainly due to increased dialysis costs (€4/session). Combining these findings with observed mortality in the model resulted in a quality-adjusted life year (QALY) gain of 1.00, with incremental costs per QALY (ICER) ranging from €36,590 to €51,386. The ICER was €15,768 when excluding all costs in additional life years. Sensitivity analyses showed the probability of cost-effectiveness was >75% at willingness-to-pay threshold of €60,000/QALY, and <30% at €20,000/QALY.

Conclusion

Compared to HD, HDF resulted in an additional year in perfect health at increased costs. The probability of cost-effectiveness is mainly driven by dialysis costs in life years gained. At a €60,000/QALY threshold, probability of HDF being cost-effective exceeded 75%. As costs may differ between countries and centers, we recommend translating our results to local settings.

Funding

  • Government Support - Non-U.S.