Renal transplantation vs hemodialysis: cost-effectiveness analysis

Chronic renal insufficiency (CRI), diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD) are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD) the only correct selection is kidney transplantation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA) of hemodialysis and kidney transplantation in patients at ESRD.

As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center "Zvezdara", Clinical Center Kragujevac and Health Center "Studenica", Kraljevo, comparable with respect to sex, age and length of treatment with the study group.

Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER). It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY) within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, phychological symptoms, existential well-being and support), difference is statistically important in favour of transplant patents.

The costs of patient therapy by hemodialysis at end-stage renal disease is far greater than by performing therapy of transplantation and maintenance, by almost three and a half times. Difference in total quality aspects of human life (physical, emotional, social, spiritual and financial) between dialysed and transplant patients is statistically significant and by 18.12% greater in transplant patients than in patients on hemodialysis.