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A cost-effective analysis of the CYCLE-HD randomized controlled trial

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journal contribution
posted on 03.06.2021, 11:23 by Daniel S. March, Adam W Hurt, Charlotte E Grantham, Darren R. Churchward, Hannah ML Young, Patrick J. Highton, Maurice Dungey, Nicolette Bishop, Alice C. Smith, Matthew PM Graham-Brown, Nicola J. Cooper, James O. Burton
Introduction: No formal cost-effectiveness analysis has been performed for programs of cycling exercise during dialysis (intradialytic cycling [IDC]). The objective of this analysis is to determine the effect of a 6-month program of IDC on health care costs. Methods: This is a retrospective formal cost-effectiveness analysis of adult participants with end-stage kidney disease undertaking in-center maintenance hemodialysis enrolled in the CYCLE-HD trial. Data on hospital utilization, primary care consultations, and prescribed medications were extracted from medical records for the 6 months before, during, and after a 6-month program of thrice-weekly IDC. The cost-effectiveness analysis was conducted from a health care service perspective and included the cost of implementing the IDC intervention. The base-case analyses included a 6-month “within trial” analysis and a 12-month “within and posttrial” analysis considering health care utilization and quality of life (QoL) outcomes. Results: Data from the base-case within trial analysis, based on 109 participants (n = 56 control subjects and n = 53 IDC subjects) showed a reduction in health care utilization costs between groups, favoring the IDC group, and a 73% chance of IDC being cost-effective compared with control subjects at a willingness to pay of £20,000 and £30,000 per quality-adjusted life year (QALY) gained. When QoL data points were extrapolated forward to 12 months, the probability of IDC being cost-effective was 93% and 94% at £20,000 and £30,000 per QALY gained. Sensitivity analysis broadly confirms these findings. Conclusion: A 6-month program of IDC is cost-effective and the implementation of these programs nationally should be a priority.

Funding

StoneygateTrust

History

School

  • Sport, Exercise and Health Sciences

Published in

Kidney International Reports

Publisher

Elsevier

Version

VoR (Version of Record)

Publisher statement

This is an Open Access Article. It is published by Elsevier under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

Acceptance date

22/02/2021

Publication date

2021-04-08

ISSN

2468-0249

Language

en

Depositor

Prof Lettie Bishop. Deposit date: 2 June 2021