Health economic evaluations: the special case of end-stage renal disease treatment

Med Decis Making. Sep-Oct 2002;22(5):417-30. doi: 10.1177/027298902236927.


This article synthesizes the evidence on the cost-effectiveness of renal replacement therapy and discusses the findings in light of the frequent practice of using the cost-effectiveness of hemodialysis as a benchmark of societal willingness to pay. The authors conducted a meta-analytic review of the medical and economic literature for economic evaluations of hemodialysis, peritoneal dialysis, and kidney transplantation. Cost-effectiveness ratios were translated into 2000 U.S. dollars per life-year (LY) saved. Thirteen studies published between 1968 and 1998 provided such information. The cost effectiveness of center hemodialysis remained within a narrow range of $55,000 to $80,000/LY in most studies despite considerable variation in methodology and imputed costs. The cost-effectiveness of home hemodialysis was found to be between $33,000 and $50,000/LY. Kidney transplantation, however, has become more cost-effective over time, approaching $10,000/LY. Estimates of the cost per life-year gained from hemodialysis have been remarkably stable over the past 3 decades, after adjusting for price levels. Uses of the cost-effectiveness ratio of $55,000/LY for center hemodialysis as a lower boundary of society's willingness to pay for an additional life-year can be supported under certain assumptions.

Publication types

  • Meta-Analysis

MeSH terms

  • Attitude to Health
  • Cost-Benefit Analysis
  • Direct Service Costs / statistics & numerical data
  • Evidence-Based Medicine
  • Health Care Costs / statistics & numerical data*
  • Hemodialysis Units, Hospital / economics
  • Hemodialysis, Home / economics
  • Humans
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / economics*
  • Peritoneal Dialysis / economics*
  • Peritoneal Dialysis, Continuous Ambulatory / economics
  • Quality-Adjusted Life Years
  • Renal Dialysis / economics*
  • Social Values
  • Technology Assessment, Biomedical
  • Time Factors
  • Treatment Outcome
  • Value of Life / economics