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Cost-Utility Analyses of Hemodialysis, Peritoneal Dialysis, and Kidney
Transplantation in Patients with End-Stage Kidney Disease: A Systematic Review
#MMPMID41384026
Wulandari W
; Alfaqeeh M
; Zakiyah N
; Shafie AA
; Suwantika AA
Clinicoecon Outcomes Res
2025[]; 17
(?): 883-895
PMID41384026
show ga
The global burden of end-stage kidney disease (ESKD) is rising, compelling
patients to increasingly confront the choice of initiating kidney replacement
therapy (KRT). Cost-utility analysis (CUA) has the advantage of incorporating
patient-reported outcomes regarding KRT. The aim of this study is to summarize
the CUA of hemodialysis (HD), peritoneal dialysis (PD), and kidney
transplantation in patients with ESKD. A systematic search was conducted to
identify relevant articles in three primary databases (PubMed, SCOPUS, and
ProQuest). CUA studies of dialysis for ESKD patients from 2000 to 2023 in all
countries were included. Non-full-text, non-English language, review articles,
systematic reviews, and studies that did not compare distinct dialysis methods
were excluded. All the information was summarized narratively. Out of the 130
studies identified, 13 met the inclusion criteria and were included in this
review. Most studies demonstrated good reporting quality, with CHEERS checklist
scores ranging from 75% to 96%. Kidney transplantation was consistently found to
be the most cost-effective KRT, offering the highest quality-adjusted life years
(QALYs) and the lowest cost per QALY in the long term, despite higher initial
expenses. PD showed better cost-effectiveness than HD in several studies. HD
generally incurred the highest costs with lower QALY gains. Cost-effectiveness
trends varied depending on regional context, healthcare perspective, and patient
comorbidities. This study found that kidney transplantation is consistently the
most cost-effective kidney replacement therapy, with lower cost per QALY and
improved quality-adjusted life years (QALY) in most settings. In particular,
transplantation showed favorable long-term outcomes despite higher initial costs,
whereas peritoneal dialysis emerged as a more cost-effective alternative to
hemodialysis, especially in resource-limited settings. These findings offer
practical implications for treatment prioritization and policy-making in both
high- and low-resource countries.
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