{"title":"Evaluating Extracorporeal Renal Replacement Therapies: Balancing Budgetary Considerations with Ethical Implications.","authors":"Gonzalo Ramírez-Guerrero, Fiammetta Zanetti, Akash Nayak Karopadi, Claudio Ronco","doi":"10.1159/000545389","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Evaluating extracorporeal therapies for end-stage kidney disease (ESKD) requires balancing cost-effectiveness with patient-centered care. With dialysis costs exceeding EUR 2 billion annually in Italy and USD 29 billion in the USA, assessing the economic implications of emerging technologies against their clinical benefits is crucial. Cost-effectiveness analysis (CEA) and health technology assessment (HTA) are widely used to evaluate healthcare interventions, yet they often fail to capture qualitative improvements in patients' quality of life. Additionally, ethical considerations remain underrepresented in these frameworks, despite their importance in guiding equitable resource allocation.</p><p><strong>Summary: </strong>This manuscript examines the landscape of extracorporeal therapies within the healthcare systems of Italy and the USA, highlighting the economic and ethical challenges in their evaluation. A novel two-dimensional framework is introduced, integrating bioethical principles - such as justice, equality, and equity - into CEA to ensure that interventions are assessed not only for their financial sustainability but also for their societal and ethical impact. By incorporating ethical considerations into CEA, the framework offers a more comprehensive approach to decision-making in healthcare resource allocation.</p><p><strong>Key messages: </strong>(1) Traditional CEA and HTA methods often overlook qualitative improvements in patient quality of life. (2) Ethical considerations, including justice and equity, should be integrated into economic evaluations of healthcare interventions. (3) A two-dimensional framework is proposed to balance economic viability with patient-centered outcomes. (4) Incorporating ethics into CEA enhances healthcare decision-making, fostering innovation and equitable patient care.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"272-280"},"PeriodicalIF":1.8000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000545389","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/28 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Evaluating extracorporeal therapies for end-stage kidney disease (ESKD) requires balancing cost-effectiveness with patient-centered care. With dialysis costs exceeding EUR 2 billion annually in Italy and USD 29 billion in the USA, assessing the economic implications of emerging technologies against their clinical benefits is crucial. Cost-effectiveness analysis (CEA) and health technology assessment (HTA) are widely used to evaluate healthcare interventions, yet they often fail to capture qualitative improvements in patients' quality of life. Additionally, ethical considerations remain underrepresented in these frameworks, despite their importance in guiding equitable resource allocation.
Summary: This manuscript examines the landscape of extracorporeal therapies within the healthcare systems of Italy and the USA, highlighting the economic and ethical challenges in their evaluation. A novel two-dimensional framework is introduced, integrating bioethical principles - such as justice, equality, and equity - into CEA to ensure that interventions are assessed not only for their financial sustainability but also for their societal and ethical impact. By incorporating ethical considerations into CEA, the framework offers a more comprehensive approach to decision-making in healthcare resource allocation.
Key messages: (1) Traditional CEA and HTA methods often overlook qualitative improvements in patient quality of life. (2) Ethical considerations, including justice and equity, should be integrated into economic evaluations of healthcare interventions. (3) A two-dimensional framework is proposed to balance economic viability with patient-centered outcomes. (4) Incorporating ethics into CEA enhances healthcare decision-making, fostering innovation and equitable patient care.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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