Analysis and interpretation of cost data in dialysis: review of Western European literature.

Background: Constant improvements in dialysis technology, combined with a growing chronic renal failure population and limited funds, have put clinicians under pressure to prescribe the most cost-effective therapies. Improvements in dialysis, which eliminates metabolic waste products and preserves a normal electrolyte and fluid balance, have enhanced the quality of care among renal patients but at high monetary cost to health systems. Several recent studies report that yearly costs of peritoneal dialysis (PD) (because of technical differences in treatment strategies) are less than hemodialysis (HD) with hospital and other costs included. However, cost analyses of dialysis modalities are not always complete. As a result they are often difficult to directly compare. Furthermore, input costs, health care organizations, and patient use of dialysis vary from country to country in important ways.

Objective: To review critically the European literature in dialysis where cost data in caring for patients is available, and maximize information about the nature of the cost data in dialysis.

Methods: Survey of published literature including an economic evaluation with cost values in Western Europe; 25 such studies were identified, described in 20 publications. The search focused primarily on articles and reports published since 1990. The appraisal of studies took place according to standard costing procedures, covering, but not limited to, specification of analytic perspective and cost components considered.

Results: Costs between dialysis modalities vary from country to country in important ways, although power to detect such differences was limited. The disclosure of details regarding costing methods ranged widely. Only four studies presented adequate descriptive information for dialysis costs.

Conclusions: Errors should be expected in all exercises to estimate dialysis costs. But, potentially misleading conclusions about the relative costs of dialysis therapies have been published in the absence of supporting evidence. Costing information in this field is often handled inconsistently and unsatisfactorily. The analysis and reporting of costs within publications concerning dialysis needs improvement. The review suggests a positive cost advantage to peritoneal dialysis over hemodialysis, but the magnitude of the difference is difficult to evaluate at this time.