Skip to main content
    • Aa
    • Aa

Economic evaluation of continuous renal replacement therapy in acute renal failure

  • Scott Klarenbach (a1), Braden Manns (a2), Neesh Pannu (a1), Fiona M. Clement (a2), Natasha Wiebe (a1), Marcello Tonelli (a1) and For the Alberta Kidney Disease Network...

Objectives: Controversy exists regarding the optimal method of providing dialysis in critically ill patients with acute renal failure. We sought to determine the cost-effectiveness of treatment strategies.

Methods: Adult subjects requiring renal replacement therapy in a critical care setting who are candidates for intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) were considered within a Markov model. Alternative strategies including IHD, and standard or high dose CRRT were compared. The model considered relevant clinical and economic outcomes, and incorporated data on clinical effectiveness from a recent systematic review and high quality micro-costing data.

Results: In the base-case analysis, CRRT was associated with similar health outcomes but higher costs by ($3,679 more than IHD per patient). In scenarios considering alternate cost sources, and higher intensity of IHD (including daily and longer duration IHD), CRRT remained more costly. Sensitivity analysis indicated that even small differences in the risk of mortality or need for long-term chronic dialysis therapy among surviving patients benefits led to dramatic changes in the cost-effectiveness of the modalities considered.

Conclusions: Given the higher costs of providing CRRT and absence of demonstrated benefit, IHD is the preferred modality in critically ill patients who are candidates for either IHD or CRRT, although this conclusion should be revisited if future clinical trials establish differences in clinical effectiveness between modalities. Future interventions that are proven to improve renal recovery after acute renal failure are likely to be cost-effective, even if very resource intensive.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. SM Bagshaw , LR Berthiaume , A Delaney , R Bellomo . Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: A meta-analysis. Crit Care Med. 2008;36:610617.

2. SM Bagshaw , KB Laupland , CJ Doig , Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: A population-based study. Crit Care. 2005;9:R700R709.

3. AN Berbece , RM Richardson . Sustained low-efficiency dialysis in the ICU: Cost, anticoagulation, and solute removal. Kidney Int. 2006;70:963968.

4. AH Briggs , R Goeree , G Blackhouse , BJ O'Brien . Probabilistic analysis of cost-effectiveness models: Choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making. 2002;22:290308.

6. K Claxton , M Sculpher , C McCabe , Probabilistic sensitivity analysis for nice technology assessment: Not an optional extra. Health Econ. 2005;14:339347.

8. MB Hamel , RS Phillips , RB Davis , Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med. 1997;127:195202.

9. A Laupacis , P Keown , N Plus , A study of the quality of life and cost-utility of renal transplantation. Kidney Int. 1996;50:235242.

10. H Lee , B Manns , K Taub , Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. Am J Kidney Dis. 2002;40:611622.

11. B Manns , JA Johnson , K Taub , G Mortis , WA Ghali , C Donaldson . Quality of life in patients treated with hemodialysis or peritoneal dialysis: What are the important determinants? Clin Nephrol. 2003;60:341351.

12. B Manns , CJ Doig , H Lee , Cost of acute renal failure requiring dialysis in the intensive care unit: Clinical and resource implications of renal recovery. Crit Care Med. 2003;31:449455.

13. C McCabe , S Dixon . Testing the validity of cost-effectiveness models. Pharmacoeconomics. 2000;17:501513.

14. RL Mehta , GM Chertow . In critically ill patients with acute renal failure, outcomes, not dollars, should drive modality choice. Crit Care Med. 2003;31:644646.

15. RL Mehta , B McDonald , FB Gabbai , A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int. 2001;60:11541163.

16. TW Noseworthy , E Konopad , A Shustack , R Johnston , M Grace . Cost accounting of adult intensive care: Methods and human and capital inputs. Crit Care Med. 1996;24:11681172.

18. N Pannu , S Klarenbach , N Wiebe , Renal replacement therapy in patients with acute renal failure: A systematic review. JAMA. 2008;299:793805.

19. C Vinsonneau , C Camus , A Combes , Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: A multicentre randomised trial. Lancet 2006;368:379385.

21. MC Weinstein , B O'Brien , J Hornberger , Principles of good practice for decision analytic modeling in health-care evaluation: Report of the ISPOR Task Force on Good Research Practices–Modeling Studies. Value Health. 2003;6:917.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 5
Total number of PDF views: 39 *
Loading metrics...

Abstract views

Total abstract views: 231 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st September 2017. This data will be updated every 24 hours.