The cost–utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

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Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost–utility of this dialysis modality yet. It was therefore our objective to study the cost–utility of HDF versus haemodialysis (HD).


A cost–utility analysis was performed using a Markov model. It included data from the Convective Transport Study (CONTRAST), a randomized controlled trial that compared online HDF with low-flux HD. Costs were estimated using a societal perspective. Probabilistic sensitivity analyses were performed to study uncertainty.


Total annual costs for HDF and HD were €88 622 ± 19 272 and €86 086 ± 15 945, respectively (in 2009 euros). When modelled over a 5-year period, the incremental cost per quality-adjusted life year (QALY) of HDF versus HD was €287 679. Sensitivity analyses revealed that this amount will not fall below €140 000, even under the most favourable assumptions like a high-convection volume (>20.3 L).


Based on accepted societal willingness-to-pay thresholds, HDF cannot be considered a cost-effective treatment for patients with end-stage renal disease at present. Apparently, minor additional costs of HDF are not counterbalanced by a relevant QALY gain.

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