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Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis

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Abstract

Background

Dialysis treatment requires considerable resources and it is important to improve the efficiency of care.

Methods

Files of all adult end-stage renal disease (ESRD) patients who entered dialysis therapy between 1991 and 1996, were studied and all use of health care resources was recorded. A total of 138 patients started with in-center hemodialysis (HD) and 76 patients with continuous ambulatory peritoneal dialysis (CAPD). Four alternative perspectives were applied to assess effectiveness. An additional analysis of 68 matched CAPD-HD pairs with similar characteristics was completed.

Results

Cost-effectiveness ratios (CER; cost per life-year gained) were different in alternative observation strategies. If modality changes and cadaveric transplantations were ignored, annual first three years’ CERs varied between $41220–61465 on CAPD and $44540–85688 on HD. If CAPD-failure was considered as death, CERs were $34466–81197 on CAPD. When follow-up censored at transplantation but dialysis modality changes were ignored, CERs were $59409–95858 on CAPD and $70042–85546 on HD. If observation censored at any change of primarily selected modality, figures were $57731–66710 on CAPD and $74671–91942 on HD. There was a trend of lower costs and better survival on CAPD, the only exception was the strategy in which technical failure of modality was considered as death. Figures of the matched CAPD-HD pairs were very close to the figures of the entire study population.

Conclusions

Compared to HD, CERs were slightly lower on CAPD.

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Authors and Affiliations

  1. Medical School, University of Tampere, Tampere, FIN-33014, Finland

    Tapani Salonen, Tuomo Reina, Heikki Oksa & Amos Pasternack

  2. Department of Medicine, Tampere University Hospital, Tampere, Finland

    Tapani Salonen & Heikki Oksa

  3. School of Public Health, University of Tampere, Tampere, Finland

    Pekka Rissanen

Authors
  1. Tapani Salonen
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  2. Tuomo Reina
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  3. Heikki Oksa
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  4. Pekka Rissanen
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  5. Amos Pasternack
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Correspondence to Tapani Salonen.

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Salonen, T., Reina, T., Oksa, H. et al. Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis. Int Urol Nephrol 39, 289–298 (2007). https://doi.org/10.1007/s11255-006-9141-2

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  • DOI: https://doi.org/10.1007/s11255-006-9141-2

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