Incremental compared with full-dose peritoneal dialysis: A cost analysis from a third-party payer perspective in Australia
Mary Ann Nicdao, Germaine Wong, Karine Manera, Kamal Sud, Surjit Tarafdar, Allison Tong, Katrina Chau, Martin Howell
Abstract
IntroductionIncremental peritoneal dialysis (PD) prescriptions, tailored to individual patient needs and residual kidney function, may offer patients greater dialysis-free time than full-dose PD and has the potential to yield substantial cost savings. We aimed to quantify the direct healthcare costs and resource utilization associated with incremental and full-dose PD from a third-party health service payer's perspective and estimate dialysis-free time and dialysis waste saved.MethodsWe recruited patients from a large dialysis service provider in Australia. We retrospectively analysed prospectively collected hospital data from 203 incident patients receiving PD over a 24-month period. Incremental PD was compared to full dose, considering costs related to consumables, multidisciplinary reviews, pathology, and in-patient costs.ResultsOf the 204 incident patients recruited in the study, 123 (60%) were prescribed incremental PD, with mean age of 62 years, and 66% being male. The total mean monthly outpatient cost ($AUD) for any dose of incremental PD was $339 (95% CI $152, -$526, p< .001) less than full dose, with PD consumables as the greatest contributor to the cost difference. At the end of the study, the mean dwell and exchange procedure times were 5065 h (4222-5908) and 455 h (403-507) lower in incremental PD than full dose, respectively, and incremental PD prescriptions saved >2 million litres of water, >9000 kg plastic and >8000 kg cardboard.ConclusionCompared to full dose, incremental PD minimizes dialysis time and is associated with lower costs and dialysis waste, driven largely by reduction in consumables use.