Abstract: FR-PO1064
Estimating the Cost-Effectiveness of Peritoneal Dialysis Compared with Hemodialysis as a Starting Modality in the United States
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Sinha, Araadhna, Symmetron Ltd, London, England, United Kingdom
- Simonic, Eric Adam, Symmetron Ltd, London, England, United Kingdom
- Sharif, Henna, Symmetron Ltd, London, England, United Kingdom
- Rinciog, Claudia I., Symmetron Ltd, London, England, United Kingdom
- Brown, Julie, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Lassagne, Reginald, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Hicks, Meagen, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Danielson, Vanessa, Vantive US Healthcare LLC, Deerfield, Illinois, United States
Background
Peritoneal dialysis (PD) and hemodialysis (HD) are the principal kidney replacement therapies for patients with kidney failure. PD offers comparable health outcomes, greater treatment flexibility, and lower resource use than in-centre HD (ICHD), however it is underutilised among incident patients in the United States (US). Recent programmes like the Advancing American Kidney Health Initiative seek to increase usage of home dialysis, including PD. We developed a de novo cost-effectiveness model to assess the comparative value of PD versus ICHD as a starting dialysis modality in routine US practice.
Methods
A Markov state-transition model was developed from a US perspective using a lifetime horizon. Incident adults with kidney failure initiating dialysis entered the model on either PD or ICHD. Health states included PD, ICHD, home HD, kidney transplantation, return to dialysis after graft failure, and death. Model inputs were identified from the recently published US Renal Data System's annual report, including treatment switching, survival and costs. Health-state utilities were sourced from published literature. The model estimated life years, quality-adjusted life years, costs and incremental cost-effectiveness. Parameter uncertainty was explored with one way sensitivity analysis (OWSA), varying each parameter individually and probabilistic sensitivity analyses (PSA), varying all parameters at once, to test the consistency of results. Finally, scenarios were explored to test structural and parameter assumptions.
Results
In base case analysis, initiating dialysis with PD was associated with lower lifetime costs and better health outcomes than starting with ICHD, demonstrating its dominance over ICHD. Initiation on PD remained dominant across explored scenarios. Findings were robust in the OWSA and PSA, supporting PD as a cost effective starting modality in the US setting.
Conclusion
This model suggests that PD is a clinically and economically superior starting dialysis modality for appropriate patients in the United States. PD's lower resource use supports its value within contemporary U.S. practice, supported by improved survival and quality of life outcomes. These findings highlight the need for broader adoption of PD where clinically appropriate, supporting recent efforts in the US to increase appropriate PD uptake.
Funding
- Commercial Support – Vantive Ltd