Reversing the Decreasing Peritoneal Dialysis (PD) Trend in Ontario: A Government Initiative to Increase PD Use in Ontario to 30% by 2010

Oreopoulos, Dimitrios G.; Coleman, Sandra B.; Doyle, Ethel

doi:10.1177/089686080702700503

Cited by 27 publications

(14 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is less than was the case 25 years ago when center HD capacity was constrained and PD use exceeded 35%. Home dialysis use is strongly promoted by provincial governments in part due to lower costs (12,13). However, there is no mandatory home dialysis first policy, and HD capacity is not severely limited; therefore, there is great variation in use by province, ranging from 30% in British Columbia to 9% in Newfoundland (9).…”

Section: Modality Distributionmentioning

confidence: 99%

Global Dialysis Perspective: Canada

Blake

2020

Kidney360

View full text Add to dashboard Cite

Section: Modality Distributionmentioning

confidence: 99%

Global Dialysis Perspective: Canada

Blake

2020

Kidney360

View full text Add to dashboard Cite

“…Starting in 2008, the Thailand National Health Insurance Fund implemented a PD-First policy by addressing important elements such as training and reimbursement ( 37 ). The Canada Ontario Ministry of Health and Long-Term Care established a provincial PD initiative in 2005 to increase use from 18% in 2005 to 30% in 2010 ( 38 ). In the United States, the Center for Medicare & Medicaid Services (CMS) implemented a prospective payment system that bundled most of the services provided to dialysis patients starting January 1, 2011 ( 39 , 40 ).…”

Section: Global Policy Overviewmentioning

confidence: 99%

A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

et al. 2015

View full text Add to dashboard Cite

Given the ever-increasing burden of end-stage renal disease (ESRD) in a global milieu of limited financial and health resources, interested parties continue to search for ways to optimize dialysis access. Government and payer initiatives to increase access to renal replacement therapies (RRTs), particularly peritoneal dialysis (PD) and hemodialysis (HD), may have meaningful impacts from clinical and health-economic perspectives; and despite similar clinical and humanistic outcomes between the two dialysis modalities, PD may be the more convenient and resource-conscious option. This review assessed country-specific PD-First/Favored policies and their associated background, implementation, and outcomes. It was found that barriers to policy-implementation are broadly associated with government policy, economics, provider or healthcare professional education, modality-related factors, and patient-related factors. Notably, the success of a given country's PD-Favored policy was inversely associated with the extent of HD infrastructure. It is hoped that this review will provide a foundation across countries to share lessons learned during the development and implementation of PD-First/Favored policies.

show abstract

“…In response to the growing demand of kidney failure and stretching of the current in-center HD resources, they attempted a PD expansion program. 15 Their committee implemented a multipronged approach without altering physician reimbursement further. They did not achieve their original target of 30% PD use by 2010; however, Ontario’s rates of home dialysis increased from 21.6% in 2012 to 26.1% in 2017, almost entirely due to a rise in PD.…”

Section: Reviewmentioning

confidence: 99%

“…A government initiative in Ontario, Canada meant to rapidly improve rates of PD use to 30% by 2010 was unsuccessful. 15 The slow growth of home dialysis in developed nations suggests that there are persistent controversies and barriers to implementation. The primary objective of this health policy briefing article is to introduce and address some of the major controversies surrounding the cost effectiveness in supporting advocacy for a “Home Dialysis First” policy from the perspective of a single-payer system in a developed nation such as Canada (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Cost Controversies of a “Home Dialysis First” Policy

Hager

Ferguson

Komenda

2019

Can J Kidney Health Dis

View full text Add to dashboard Cite

Purpose of review: Kidney Failure is highly prevalent and uses a disproportionate amount of health care funding. In Canada (excluding Quebec), 37 647 people were living with kidney failure in 2016. The single-payer Canadian health care system spends approximately 1.2% of their annual budget on kidney failure. In 2016, 58.4% of patients with kidney failure in Canada (excluding Quebec) were on dialysis as opposed to living with a functioning kidney transplant. Home dialysis modalities including peritoneal dialysis (PD) and home hemodialysis (HD) were used by 18.9% and 4.7% of these patients, respectively. In-center HD and home dialysis (PD and home HD) are often considered equally efficacious and have similar impacts on quality of life. Despite cost minimization analyses suggesting that home dialysis offers cost savings over in-center HD, there has been a slow uptake of home dialysis in developed nations over time, suggesting that controversies and barriers to implementation currently exist. The primary objective of this health policy briefing article is to introduce and address some of the major controversies surrounding the cost effectiveness in supporting advocacy for a “Home Dialysis First” policy with a primary focus on single-payer systems in a developed nation such as Canada. Sources of information: Canadian Agency for Drugs and Technologies in Health (CADTH), Canadian and US epidemiologic databases, national/international conference presentations, primary literature review, and discussion with experts within the field of home dialysis. Methods: We have conducted a focused primary literature review alongside individuals with expertise in the field of home dialysis to discuss the cost controversies surrounding the implementation of a “Home Dialysis First” policy. Key findings: First, the primary literature is limited to mostly observational studies which are highly variable in study design and content. Local economic assessments, however, have provided convincing data for home dialysis cost savings in Canada. Second, the cost of delivering dialysis differs significantly throughout the world, explained by differing costs of labor and supplies in developing nations. Third, the indirect patient costs of water, energy, and home modifications are often barriers to implementation and may be overcome by introducing cost reimbursement programs. Fourth, home dialysis requires upfront training costs. We explore the impact of premature switches from home dialysis to in-center HD or a functioning kidney transplant on overall cost savings. Fifth, we discuss the effect of physician financial incentives and program funding on the uptake of home dialysis. Finally, we introduce the controversial topic of comparing the societal value of freedom of modality choice against the societal cost savings of a “Home Dialysis First” policy. Limitations: Narrative reviews, due to their inherently reduced methodological quality in comparison with systematic reviews, may expose our collected literature to selection bias. We have attempted to compose a diverse collection of available literature alongside consensus expertise to provide a fair and concise review of home dialysis cost controversies. Implications: Implementation of a “Home Dialysis First” policy would be a disruptive change to kidney failure care in Canada. To make informed policy decisions, we should recognize the cost savings associated with home dialysis in developed nations, the significance of patient-borne costs as a barrier to implementation, the impact of training costs and early modality switching in home dialysis, the lack of evidence regarding physician financial incentives, and the importance of program funding. Ultimately, we must consider the societal value of freedom of patient modality choice in comparison with the potential cost savings of a “Home Dialysis First” policy.

show abstract

Reversing the Decreasing Peritoneal Dialysis (PD) Trend in Ontario: A Government Initiative to Increase PD Use in Ontario to 30% by 2010

Cited by 27 publications

References 6 publications

Global Dialysis Perspective: Canada

Global Dialysis Perspective: Canada

A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

Cost Controversies of a “Home Dialysis First” Policy

Contact Info

Product

Resources

About