The aim of this health technology assessment (HTA) is to inform policy questions regarding the optimal treatment for eligible patients and effective methods of implementation support for the various dialysis options reviewed through an assessment of the clinical effectiveness, cost-effectiveness, patient experiences and perspectives, ethical issues, and implementation issues of dialysis modalities for the treatment of end-stage kidney disease (ESKD).

Contents

• Reviewers
• Acknowledgements
• Abbreviations
• Protocol Amendments
• Executive Summary
  • Issue
  • Objectives and Research Questions
  • Clinical Evidence
  • Economic Evidence
  • Patient Perspectives and Experiences Evidence
  • Ethics
  • Implementation Issues
  • Conclusions
• Introduction
  • Clinical and technology background
• Policy Questions
• Analytic Framework
• Objectives
  • Research questions
• Clinical Review
  • Methods
  • Results
  • Summary of clinical results
• Economic Evaluation
  • Review of economic studies
  • Primary economic evaluation
  • Summary of results of the economic analysis
• Patient Perspectives and Experiences Review
  • Methods
  • Results
  • Summary of results
• Ethical Issues
  • Introduction
  • Methods
  • Background and context
  • Macro-level considerations
  • Meso-level considerations
  • Micro-level considerations
  • Summary of results
• Implementation Issues
  • Methods
  • Results
  • Summary of results
• Discussion
  • Integration of findings
  • Generalizability of findings
  • Limitations
  • Directions for future research
• Conclusions
• References
• Appendix 1. Analytical Framework
• Appendix 2. Literature Search Strategy
• Appendix 3. List of Included Studies — Clinical Review
• Appendix 4. Study Selection Flow Diagram — Clinical Review
• Appendix 5. Full-Text Screening Checklist — Clinical Review
• Appendix 6. Data Extraction Form — Clinical Review
• Appendix 7. Study and Patient Characteristics — Clinical Review
• Appendix 8. Detailed Outcome Data — Clinical Review
• Appendix 9. Critical Appraisal — Clinical Review
• Appendix 10. Validity of Outcomes for Health-Related Quality of Life Instruments — Clinical Review
• Appendix 11. List of Studies Excluded and the Reasons for Exclusion — Clinical Review
• Appendix 12. Modelling Mortality — Economic Review
• Appendix 13. Clinical Inputs on Relative Efficacy and Safety Estimates, Applied in Scenario Analyses
• Appendix 14. Subcategories of Costs by Study (2015 CAN $) — Economic Review
• Appendix 15. Additional Costs Inputs in the Economic Review
• Appendix 16. Sensitivity Analyses — Varying Discount Rates, Time Horizon, and Older Age (All Modalities)
• Appendix 17. Scenario Analyses — Prevalent Patients (all modalities)
• Appendix 18. Reference Case Results, All Dialysis Modalities
• Appendix 19. Findings From Sensitivity Analyses, PD Versus Conventional ICHD
• Appendix 20. Findings From Sensitivity Analyses — Home HD Versus Cv ICHD
• Appendix 21. Findings from Sensitivity Analyses — HHD Versus PD
• Appendix 22. Findings from Additional Sensitivity Analyses
• Appendix 23. Quality Assessment Instrument — Patient Preferences Review
• Appendix 24. Study Selection Flow Diagram — Patient Preferences Review
• Appendix 25. List of Included Studies — Patient Preferences Review
• Appendix 26. List of Excluded Studies — Patient Preferences Review
• Appendix 27. Characteristics of Included Studies — Patient Preferences Review
• Appendix 28. Quality Assessment of Included Studies — Patient Preferences Review
• Appendix 29. Implementation Surveys — Implementation Review

Dr. Michael Copland has received funding from NxStage Medical Inc. for travel, educational lectures and writing articles/editorials, and from Baxter Health Care (Global) for travel. No other conflicts were declared.

Suggested citation:

Dialysis Modalities for the Treatment of End-Stage Kidney Disease: A Health Technology Assessment. Ottawa: CADTH; 2017. (CADTH Optimal Use Report; vol.6, no.2b).

Disclaimer: This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared, and it was guided by expert input and advice throughout its preparation.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada.

PROSPERO Registration Number: CRD42016046980