Document Detail

A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.
MedLine Citation:
PMID:  16997929     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. METHODS: We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. RESULTS: Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. CONCLUSION: The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.
Chris P Lee; Glenn M Chertow; Stefanos A Zenios
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Medical decision making : an international journal of the Society for Medical Decision Making     Volume:  26     ISSN:  0272-989X     ISO Abbreviation:  Med Decis Making     Publication Date:    2006 Sep-Oct
Date Detail:
Created Date:  2006-09-25     Completed Date:  2006-12-26     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8109073     Medline TA:  Med Decis Making     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535-49     Citation Subset:  IM    
Operations and Information Management Department, The Wharton School, University of Pennsylvania, PA, USA.
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MeSH Terms
Aged, 80 and over
Computer Simulation / statistics & numerical data*
Costs and Cost Analysis
Kidney Failure, Chronic / economics,  therapy*
Kidney Transplantation / economics,  statistics & numerical data
Middle Aged
Models, Statistical*
Renal Dialysis / economics,  methods*
Survival Analysis
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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