The STARRT trial: a cost comparison of optimal vs sub-optimal initiation of dialysis in Canada

Abstract

Background:

Sub-optimal transitioning of patients from chronic kidney disease (CKD) to end stage renal disease (ESRD) may result in poor clinical outcomes and increased healthcare costs. The objectives of this study were to estimate the average total cost per patient who requires initiation of renal replacement therapy (RRT) stratified by status at initiation; optimal (RRT initiation as an outpatient with an arterio-venous [AV] Fistula, Graft or Peritoneal Dialysis [PD] catheter), and sub-optimal (RRT initiation as an inpatient and/or via central venous catheter [CVC]).

Methods:

Data from the Study To Assess Renal Replacement Therapy (STARRT), a Canadian, multi-centre, 6 month retrolective study (n = 339), were used for this analysis. Unit costs for resources were obtained from participating hospitals, the literature, and/or standard costing sources. The analysis was performed from the perspective of healthcare payors and reported in 2011 Canadian Dollars (CAD). A propensity score technique was applied to control for potential confounders between the two groups.

Results:

Two hundred of the eligible patients for analysis (61.9%) were sub-optimally and 123 (38.1%) were optimally prepared. For this analysis, 106 “matched” pairs were used. The average total cost per patient was estimated to be $63,225 (with a 95% CI ranging from $58,663–$67,958) for the sub-optimally initiated patients, and $39,260 (with a 95% CI ranging from $35,683–$43,007) for the optimally initiated patients (p < 0.001).

Limitations:

Costs were calculated utilizing a conservative approach, using the cheapest available prices for medications and other resources. Assumptions had to be made for the costing of dialyses.

Conclusion:

The results of this study indicate, after adjusting for potential confounders, that optimally initiated patients for RRT have significantly lower healthcare-associated costs compared to sub-optimally initiated patients.

Key words::

• cost comparison
• dialysis
• Canadian
• STARRT

Transparency

Declaration of funding

This research was funded by Janssen Inc. The sponsor provided the data for this analysis.

Declaration of financial relationship

PIVINA Consulting Inc. was hired by Janssen Inc. to conduct this research. Dr Fernando Camacho analyzed the original STARRT study data as a consultant to Janssen Inc. Dr Lou Marra and Farah Jivraj (at the time of conducting the study) are/were working for Janssen Inc. Drs Phil McFarlane and David Mendelssohn were principal investigators of the original STARRT study and consultants for Janssen Inc.

Acknowledgements

No non-author assistance in the preparation of this article is to be declared.