A Prospective Study Of Quality Of Life And Cost-Utility Of Renal Replacement Therapy

Objiective:To measure the quality of life(QOL) of patients on RRT(renal replacement therapy) and assess the cost-utility of renal transplantation compared with dialysis.Methods:A prospective study of end-stage renal disease patients were followed up to three months after renal replacement therapy. The study population included 196 patients(renal transplant n=63, hemodialysis n=82 and ambulatory peritoneal dialysis[CAPD] n=51) at six hosipitals of Sichuan province .Health-related quality of life was assessed using the WHOQOL-BRIEF questionnaire.Utilities (quality-of-life weights) were estimated by Rating Scale Technique so as to conduct CUA( cost-utility analysis). Costs were collected from financial department and patient interview.Results:By three months after RRT,the health-related quality of life scores hadimproved compared to pre-therapy at three domains:Physical function (PHYS), Psychological function (PSYCH),Envirement (ENVIR) ,General health(GH) and total scores,while the scores of Social relationships (SOCIL) was similar. Renal transplantation(RT) and ambulatory peritoneal dialysis (CAPD) improved significantly at four domains n GH and total scores after therapy. Hemodialysis(HD) improved significantly at PHYS n PSYCH ^ GH .After therapy,among HD > RT and CAPD , RT had higher scores in every demensions than HD,while RT and CAPD was similar . CAPD had higher scores in ENVER. than HD. The differents of three groups in acquired HRQOL scores were mainly in PSYCH > SOCIL and total scores. RT improved more scores at PHYS ^ SOCIL and total scores than HD, CAPD improved more scores at SOCIL and total scores than SOCIL and total scores ,while RT and CAPD was simi lar . The utility values after three RRT were respectively 0.5399 ±0.013 (RT) , 0.4508 ±0.014(HD), 0.5122 + 0.099(CAPD).The mean direct cost of the first three months of renal transplant was higher significantly than dialysis (RT and CAPD) . Over the three months, the average cost per quality-adjusted life year(QALY) for patients after CAPD was lower than RT ,even than HD. Compared with HD and RT, incremental cost analysis showed that CAPD was still ecnomic. Sensitivity analysis showed that CAPD was more effective than RT or HD when AQALY varied in the limit of 95% confidence interval.However thecost-utility of RT and HD were varing with AQALY level. Conclusions:End-stage renal disease patients had a lower of quality life, the renalreplacement therapy could improve there mean health-related quality oflife,mainly manifested at PSYCH,ENVIR , GH. Renal transplantation and CAPD provided a considerable improvement in health-related quality of life at PSYCH and SOCIL .The costs of three groups in the early stage of RRT were difirent significantly, transplantation was more costly than dialysis in early stage, while the cost of CAPD and HD had no statistical difference.Cost-utility analysis showed that CAPD was a more favorablecost-utility ratio when compared with RT and HD .