Friday, 3 December 2010

Cost Comparison of Peritoneal Dialysis Versus Hemodialysis

Looking through some old links I'd collected, I came across a research paper from 2009. It makes interesting reading.

The article covers a cost comparison study looking at patients who started on dialysis between January 1st 2004 and December 31st 2006. It examined 463 patients, and paired up those on peritoneal dialysis with those in equivalent health on hemodialysis - it's important is such studies to match equivalent patients, to remove other variables from any differences found.

Because in the United States most dialysis patients have their costs paid by the Medicare ESRD system, there was a lot of data available for analysis by the researchers, who examined the use and cost of healthcare services during a 12-month period.

On a per-patient basis, those initiating dialysis with HD averaged 20 more outpatient visits over 12 months compared with matched patients in the PD group. The HD patients also had nominally more ED visits (mean [95% CI], 3.3 [2.1-5.0] vs 2.3 [1.3-3.5] for PD; P = .28). Over the 12-month period of follow-up, more HD patients were hospitalized (80% vs 50% for PD, P <.01).

The median (IQR) total per-patient healthcare costs were $43,510 higher among HD patients than among PD patients over 12 months ($173,507 [$98,706-$335,719] vs $129,997 [$73,212-$207,578], P = .03). Many of the cost differences between hemodialysis patients and peritoneal dialysis patients were quite spectacular. Such as the median (IQR) per-patient inpatient costs were $39,851 ($6089-$140,125) for HD patients versus $651 ($0-$40,591) for PD patients (P <.01). Read that again. You didn't imagine it. Read it again!

So given these costs, you might wonder a bit about the following statistic:

PD was the initial dialysis modality for only about 12% of patients in the study. In prior research, 7% to 27% of patients with ESRD in the United States have been reported to initiate dialysis with PD.

And yet peritoneal dialysis is significantly less expensive! And PD patients are much less likely to be hospitalised.

It makes you wonder if someone is suggesting to doctors that hemodialysis is a better choice, perhaps encouraging them to send patients to an HD clinic.