Economic Evaluations in Renal Replacement Therapy

Renal replacement therapy (RRT) encompasses dialysis and kidney transplantation to sustain life in patients with end-stage renal disease. Economic evaluations in this field appraise costs, health outcomes and cost-effectiveness to guide clinical practice and health policy. Analyses often compare haemodialysis with peritoneal dialysis, quantify the long-term savings of kidney transplantation, and model the budget impact of different treatment strategies. Methodologies such as propensity score matching and Markov modelling are applied to observational data to estimate healthcare expenditures, survival gains and quality-adjusted life years (QALYs). In many high-income countries, transplantation emerges as cost-effective within a few years despite higher initial costs, whereas peritoneal dialysis is often less expensive than in-centre haemodialysis over the lifetime horizon. In low- and middle-income settings, policy-level evaluations examine first-line dialysis choices under universal health coverage and forecast the financial burden of growing dialysis populations. Collectively, these studies inform resource allocation, highlight the value of early intervention and underscore the global challenge of delivering affordable, high-quality RRT.

Research from Nature Portfolio

Recent analyses have used real-world register data and matching methods to compare the costs of kidney transplantation and dialysis. One study employed propensity score matching in a Swedish cohort to generate hypothetical transplant dates for dialysis patients, finding that transplantation incurs higher healthcare costs in the first year but yields substantial savings in subsequent years, and remains clearly cost-effective when long-term health benefits are accounted for. A second investigation compared haemodialysis and peritoneal dialysis over a fourteen-year follow-up in Taiwan using matched pairs. Lifetime projections indicated nearly identical life expectancy and quality-adjusted survival for both modalities, but higher cumulative costs for haemodialysis, resulting in a lower cost per QALY for peritoneal dialysis. These findings reinforce the importance of modality choice in long-term economic planning for dialysis services.

Economic Evaluations in Renal Replacement Therapy publication trend

The graph below shows the total number of articles in economic evaluations in renal replacement therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Quality-adjusted life year (QALY): A composite measure combining length and quality of life used to assess the value of medical interventions.

Incremental cost-effectiveness ratio (ICER): The additional cost required to gain one QALY (or life year) when comparing two interventions.

Propensity score matching: A statistical technique that pairs individuals in different treatment groups based on similar baseline characteristics to reduce bias in observational comparisons.

Markov model: A mathematical framework that simulates transitions between health states over time, used to project costs and outcomes in chronic disease analyses.

References

1. Healthcare costs after kidney transplantation compared to dialysis based on propensity score methods and real world longitudinal register data from Sweden. Scientific Reports (2023).
2. Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score. Scientific Reports (2016).
3. Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities. PLOS ONE (2012).
4. Healthcare costs of patients on different renal replacement modalities – Analysis of Dutch health insurance claims data. PLOS ONE (2019).
5. Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia. PLOS ONE (2017).