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Abstract: TH-PO386

Increased Peritoneal Dialysis as Initial Treatment Modality: A Canadian Costing Analysis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ferguson, Thomas W., Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Whitlock, Reid, University of Manitoba, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
  • DiNella, Michelle SJ, Seven Oaks General Hospital Research Centre, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
Background

Kidney failure is increasing in prevalence in Canada. Patients with kidney failure are often treated with dialysis: either hemodialysis (HD) or peritoneal dialysis (PD). There are economic considerations relevant to these therapies, with HD provided in hospital costing over $60,000 and home dialysis (HD or PD) costing between $35,000 and $45,000 per patient annually. Increasing home PD as a modality choice may afford the health care system substantial cost savings.

Methods

We aimed to evaluate the cost-utility of scenarios in which the number of patients offered PD as initial treatment modality is increased to 30% and 40% of incident dialysis starts (baseline Canadian incidence: 20.8%). We accomplished this by performing an incremental cost-utility analysis from the perspective of the Canadian public health payer including all costs related to treating kidney failure with dialysis in the Canadian adult incident dialysis population using data from the Canadian Organ Replacement Register (CORR) between 2004 and 2013. Threshold analysis was performed on the relative risk of infections and hospitalizations from increased PD prescription. Second order Monte Carlo simulations were performed to evaluate parameter uncertainty. Our outcomes were expressed as cost per quality adjusted life years.

Results

Increasing initial uptake of PD to 30% resulted in an average cost savings of $3,132, and increasing uptake to 40% resulted in an average cost savings of $6,529 ($33,970 per new additional PD patient initial therapy over a lifetime horizon). The models were robust to changes in the risk of infection and hospitalization, requiring over 10-fold increased risk of infection, 7.6-fold increased risk of cardiovascular-related hospitalization, or 2.5-fold increased risk of all-cause hospitalization to reach cost neutrality. Retrospectively applying these findings to the Canadian incident dialysis population for the 10 years between 2004 and 2013 would have resulted in cost savings of $123.1 million and $256.7 million in the 30% and 40% scenarios respectively.

Conclusion

Policy recommendations to increase the initial prescription of home peritoneal dialysis should be considered and are highly cost-effective.

Funding

  • Commercial Support