Peritoneal Dialysis Cheaper than Hemodialysis Worldwide

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HONG KONG—Peritoneal dialysis (PD) is much less expensive than hemodialysis (HD) in most places around the world, including North America, a new cost analysis has confirmed. Therefore, since the two modalities are clinically equivalent, PD should be used more, according to investigators.

Their study—which they published online in Nephrology Dialysis Transplantation and presented at the 2013 World Congress of Nephrology—showed the cost of HD is between 1.25 and 2.35 times higher than that of PD in five developing and 17 developed countries. In the U.S., for example, the HD:PD cost ratio is 1.29:1 and in Canada it is 1.9:1.

“While I understand that it is rather difficult in the U.S.to have a PD-first policy or a target percentage of PD use, it is clear that something could be done to improve PD education and awareness among doctors,” lead investigator Aakash Nayak Karopadi, BE, MSc, from the International Renal Research Institute Vicenza, San Bortolo Hospital, Vicenza, Italy, told Renal & Urology News. “Only 7% of dialysis in the U.S. is done with PD. If this percentage in the U.S. was at the world average of 12%, an additional 18,000 patients would have been on peritoneal dialysis, which would have lead to an annual savings of nearly $ 360 million to the American economy.

Karopadi and his co-investigators in Italy searched the published literature for studies on the cost and use of PD and HD, and mailed questionnaires to senior nephrologists in countries from which no published data were available. They then tabulated the results for 46 countries.

PD:HD cost ratios range from 2.35 in Hong Kong, where there is a PD-first policy, to 0.22 in Egypt. Furthermore, the rates of PD per million people vary from 0.06 in Nigeria to 488.5 in Hong Kong. The rates of HD per million people run from 0.2 in Ghana to 2,107 in Japan and Taiwan.

In the U.S. the rate of PD per million people is 87 and that for HD is 1,157 (the HD rate is third-highest after Japan and Taiwan). The U.S. Renal Data System 2012 Annual Report states that the annual per-patient HD cost is approximately $87,500 while for PD it is $66,750.

Karopadi and his team are also working on a PD remote monitoring system that will reduce infection and overall complication rates in PD patients using an IPad application that allows image and video transfer. The application is Institutional Review Board approved and is currently undergoing tests on patients in a university hospital in the U.S. While the application will be first made available in the U.S., the researchers aim to reach out to other countries as well through future partnerships.

The investigators also performed analyses that indicate countries with a higher Human Development Index score—a composite of life expectancy, educational level, and income—have higher costs of HD relative to PD, as do countries with a higher prevalence of PD per million population. Conversely, the HD:PD cost ratio decreases with increased percentage of private healthcare in countries' total health care expenditures.

Governments can effectively promote PD use by PD-first programs, the team concluded. They noted that other strategies that are particularly effective in developing countries include local manufacturing of the PD bags or reduction of PD-bag import duties.

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