1. The STARRT Trial Source: Piwko C, Vicente C, Marra L, et al. The STARRT trial: a cost comparison of optimal vs sub-optimal initiation of dialysis in Canada. J Med Econ. 2011.

2. Background: It is important for the patients with chronic kidney disease (CKD) to transition optimally from CKD to end-stage renal disease (ESRD). Sub- optimal transitioning may lead to poor clinical outcomes leading to increased healthcare costs. This study aimed to estimate the average total cost per patient who requires initiation of renal replacement therapy (RRT).

3. Aim: To estimate the average total cost per patient who requires initiation of 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]).

4. Methods: Study details: Canadian, multicenter, 6-month retrolective study. Number of patients: 339 were enrolled in to the study. Unit costs for resources were obtained from participating hospitals and analysis was performed from the perspective of healthcare payors and reported in 2011 Canadian Dollars (CAD).

5. Results: Average total cost per patient in each segment of population studied is mentioned in the table below:

6. Study Limitations: The two limitations of the study were as follows: Costs were calculated using the cheapest available price of medications and other resources (conservative approach). Assumptions had to be made for the costing of dialyses.

7. Conclusion: Optimal RRT initiation is associated with significantly lower healthcare costs compared to sub-optimally initiated patients.