Background

Kidney replacement therapy (KRT) is a lifesaving but costly treatment for patients with end-stage kidney disease (ESKD). The objective of this study was to review full economic evaluations comparing KRT modalities specified as hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) for patients with ESKD.

Methods

We conducted a systematic review of the literature from PubMed, Embase, EconLit (EBSCO), Web of Science, Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effects (DARE), and CRD Health Technology Assessment Database from inception until 5 January 2020. Full economic evaluations were included if they compared three forms of KRT specified as PD, HD, and KT. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Results

Ten studies were identified in the review. The majority of the studies were model-based evaluations and included a cost-utility analysis. Four studies were conducted from a public healthcare perspective, three from a societal perspective, and three from a third-party payer perspective. None of the studies adequately addressed all the applicable items of the CHEERS checklist. The most infrequently reported items were characterizing heterogeneity, target population, and characterizing uncertainty. There is a lack of studies that conduct from a societal perspective and take into account characterizing heterogeneity. All included studies indicate that KT is the most cost-effective KRT modality, with either a dominant position over HD and PD or an incremental cost-effectiveness ratio well below the accepted willingness-to-pay threshold. The majority of studies suggest that PD is less costly and offers comparable or better health outcomes than HD.

Conclusions

Our systematic review suggests that KT is the most cost-effective KRT modality, but there is no firm conclusion about the cost-effectiveness of HD and PD. Further economic evaluations can be conducted from a societal perspective and detail the evidence for subsets of patients with different characteristics.

中文翻译：

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肾脏替代治疗方式的成本效益：全面经济评估的系统回顾

 背景

对于终末期肾病 (ESKD) 患者来说，肾脏替代疗法 (KRT) 是一种挽救生命但费用昂贵的治疗方法。本研究的目的是回顾比较针对 ESKD 患者的血液透析 (HD)、腹膜透析 (PD) 和肾移植 (KT) 等 KRT 模式的完整经济评估。

 方法

我们对来自 PubMed、Embase、EconLit (EBSCO)、Web of Science、Cochrane 图书馆、国家卫生服务经济评估数据库 (NHS EED)、评论和传播中心 (CRD) 评论摘要数据库的文献进行了系统回顾。效果 (DARE) 和 CRD 卫生技术评估数据库从成立到 2020 年 1 月 5 日。如果比较指定为 PD、HD 和 KT 的三种 KRT 形式，则包括完整的经济评估。使用综合健康经济评估报告标准（CHEERS）清单评估纳入研究的报告质量。

 结果

审查中确定了十项研究。大多数研究都是基于模型的评估，并包括成本效用分析。四项研究是从公共医疗保健角度进行的，三项研究是从社会角度进行的，三项研究是从第三方付款人的角度进行的。没有一项研究充分解决了 CHEERS 检查表中的所有适用项目。最不常报告的项目是描述异质性、目标人群和描述不确定性。缺乏从社会角度进行并考虑异质性特征的研究。所有纳入的研究都表明，KT 是最具成本效益的 KRT 模式，要么比 HD 和 PD 占据主导地位，要么增量成本效益比远低于公认的支付意愿阈值。大多数研究表明，与 HD 相比，PD 成本更低，并且提供可比或更好的健康结果。

 结论

我们的系统评价表明 KT 是最具成本效益的 KRT 模式，但关于 HD 和 PD 的成本效益还没有明确的结论。可以从社会角度进行进一步的经济评估，并详细说明具有不同特征的患者子集的证据。