An opportunity for improved engagement and transparency: A systematic review of renal dialysis cost effectiveness and discrete choice experiment studies

Much attention is given to patient and provider engagement, cost, and quality. Nephrology is in a unique position to examine the intersection of these issues given kidney dialysis is delivered at a high cost to chronically ill patients. Annual dialysis treatments in Canada range from $56,000-$107,000 per patient dependent on modality. Economists quantify the preferred modality by calculating cost effectiveness through quality-adjusted life years or determining utilization through Discrete Choice Experiments (DCEs). Cost-effectiveness studies identify peritoneal dialysis as the most economical, yet it is the least used. Discrete choice experiments address patient preferences but rarely include cost attributes. This presents a unique paradigm: cost studies do not include patient or physician perspectives, and DCEs do not consider cost. This systematic review of dialysis cost-effectiveness studies and DCEs identifies an opportunity to increase engagement and transparency by involving all care partners in assessing quality and cost.