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Should the medicare ESRD program pay for daily dialysis? An ethical analysis
Priya Anantharaman1, Alvin H Moss
1Section of Nephrology, West Virginia University School of Medicine, Morgantown, WV 26506, USA. panantharaman@hsc.wvu.edu
Advances in Chronic Kidney Disease
|July 3, 2007
Summary
Daily dialysis shows promise for improving blood pressure and solute clearance in end-stage renal disease (ESRD) patients. However, insufficient evidence currently supports its cost-effectiveness or improved survival for Medicare funding.
Area of Science:
- Nephrology
- Public Health
- Health Economics
Background:
- End-stage renal disease (ESRD) is a growing epidemic in the US.
- Conventional dialysis has unacceptably high mortality and complication rates.
- Increased dialysis frequency, such as daily dialysis, is being explored to improve outcomes.
Purpose of the Study:
- To evaluate the evidence base for daily dialysis.
- To determine if daily dialysis justifies funding by the Medicare ESRD Program.
- To identify ethical criteria for allocating medical resources for dialysis therapies.
Main Methods:
- Review of observational studies on daily dialysis.
- Analysis of existing data on blood pressure, solute clearance, survival, anemia, and quality of life.
- Examination of potential cost-effectiveness and ethical considerations for Medicare funding.
Main Results:
- Daily dialysis consistently improves blood pressure and solute clearance.
- Evidence for improved patient survival, anemia, and quality of life is unclear.
- Large-scale implementation costs are substantial, and current evidence is insufficient for Medicare funding.
Conclusions:
- There is insufficient evidence to recommend Medicare funding for daily dialysis.
- Randomized controlled trials comparing conventional, short daily, and long nocturnal hemodialysis are needed.
- Ethical criteria for resource allocation must be considered for new dialysis therapies.
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