Cost/Utility Study of Peritoneal Dialysis and Hemodialysis in Chile

Abstract

In Chile the reimbursement/patient/year for chronic peritoneal dialysis (PD) is US$14,654 and for chronic hemodialysis (HD) US$10,909. However, no study comparing global (direct plus indirect) costs has been performed in our country. Our research objective was to compare global costs and quality of life between the two therapies. Patients ( n = 159) from five selected dialysis units in Chile [57 patients on PD (50 on automated PD) and 102 on standard HD (3 x 4 hours weekly)] were retrospectively studied. No patient had previously received the alternate therapy. Items analyzed were quality of life, customer satisfaction, direct and indirect costs, annual global costs, and cost/utility index. Mean age on HD was 54.14 ± 16.01 years and on PD 49.76 ± 18.88 years ( p > 0.05). No differences in the distribution of diabetic patients between the therapies were found. Hemodialysis and PD groups did not have differences in the quality of life index, although there was better customer satisfaction with PD than with HD. Direct and indirect costs were calculated. We found significant differences in favor of PD in erythropoietin consumption (2.24 ± 1.57 vials/week on HD and 1.35 ± 0.85 vials/week on PD, p < 0.05) and working time (31.0 ± 13.3 hours/week on HD and 38.5 ± 12.2 hours/week on PD, p < 0.05). The quality life index (Health-Related SF-36 Health Survey) was 65.75 on HD and 66.88 on PD. Annual global costs were US$20,803 for HD and US$20,742 for PD. The cost/utility index was 3.16 for HD and 3.10 for PD. Patients on PD have an advantage related to erythropoietin consumption and working capacity compared with HD patients. Addition of related indirect costs to reimbursements gives a more accurate insight into treatment costs. Considering all these parameters, we did not find significant differences between HD and PD in quality life index, cost/utility index, or annual global cost in this Chilean end-stage renal disease population.

The Impact of Dialysis Modality on Quality of Life: A Systematic Review

“…All these differences were in favour of PD. Although Pacheco et al (2007) noted favourable QOL scores for PD patients in seven of the eight dimensions, none was statistically significant.…”

Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease

“…The better outcomes of HD may also be due to patients’ better economic status. Patients in better economic status may prefer HD because they are less concerned about the loss of productivity due to the treatment [ 5 , 28 ].…”

Gaining Efficiencies: Resources and Demand for Dialysis around the Globe

“…Research reports from Eastern and Western Europe suggest that PD costs are similar to, or lower than HD costs [41–43,70,76]. And although PD is often perceived to be more expensive than HD in developing countries because of relatively low costs of labor and space compared with high costs of imported supplies, several published analyses disavow this perception, showing that PD treatment is, in fact, often less expensive than HD in the developing world [41,44,46,47,74,77]. Further, whereas delivery of HD is largely dependent on the availability of trained nurses and other dialysis personnel, PD is a home‐based therapy that is performed independently by the patient—an especially important consideration in areas where trained HD workers are in short supply.…”

“…Estimates for Mexico include both direct (e.g., solutions, drugs, lab tests, hospitalizations) and indirect (transportation, lost productivity) costs of care. Cost input estimates for Chile are based on a study by Pacheco et al examining direct (dialysis, iron supplementation, erythropoiesis stimulating agents, hospitalization) and indirect (workplace productivity, transportation) costs of each modality, indexed to health‐related quality of life [74].…”