‘Home dialysis first’ approach more cost-effective in 10-year study vs in-center care
Patients who initiated kidney replacement therapy on peritoneal dialysis were treated more cost-effectively than patients who were started on in-center hemodialysis, according to results of a cost-analysis conducted in Canada.
These findings suggest treating patients with a “PD first approach” may lead to lower lifetime costs of care for patients with end-stage kidney disease, Paul Komenda, MD, MHA, of the University of Manitoba and Seven Oaks Hospital Chronic Disease Innovation Centre in Winnipeg, told Healio Nephrology.
“There are many different paths a patient can take when they begin dialysis, and some of these paths are influenced by providers and payers,” Komenda said when explaining the rationale behind conducting the study. “Payers should try to get the best value for money while optimizing patient choice of therapy. We wanted to see which approach was optimal from this perspective in the real world.”
Researchers included 39,318 patients who initiated kidney replacement therapy (KRT) between 2004 and 2013. Investigators used a cost-simulation model to compare costs for patients on PD vs. those on hemodialysis during a period of 10 years. Considered costs included all those directly related to dialysis (eg, human resources, consumables and equipment, medications and capital expenditures), as well as costs related to transplant, infections and hospitalizations for kidney failure treatments.
Researchers elaborated on the model, which they noted is from the perspective of the health care payer.
“Our model provides a comprehensive tool by which the cost-utility of KRT can be described in an incident adult maintenance dialysis population,” they wrote. “In addition, this tool can account for changes in patient dialysis modality, and model inputs can be adjusted to account for differences in cost assumptions between locations and populations.”
During the 10-year period, results showed the cost-utility ratio for all patients initiating dialysis was $103,779/quality-adjusted life years [QALYs] compared with no treatment.
Total mean cost per patient was estimated to be $350,774, with total QALYs per patient estimated at 3.38.
When comparing costs between the two modalities, researchers determined patients who initiated on facility-based hemodialysis were treated at a cost-utility ratio of $104,880/QALY, while patients who initiated on home PD were treated at a cost-utility ratio of $83,762/QALY.
“A PD first [approach] is supported from a cost-effectiveness perspective, while also taking into account patient quality of life,” Komenda said. “Likely a ‘home first’ approach is optimal (including home hemodialysis and PD), [though] our numbers were too small in the data examined to make this conclusion.
“We are moving forward with a home first approach in our province to try to start more patients on PD or home HD first.”