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Erschienen in:
01.03.2007 | Original Paper
Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis
Erschienen in: International Urology and Nephrology | Ausgabe 1/2007
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Background
Dialysis treatment requires considerable resources and it is important to improve the efficiency of care.
Methods
Files of all adult end-stage renal disease (ESRD) patients who entered dialysis therapy between 1991 and 1996, were studied and all use of health care resources was recorded. A total of 138 patients started with in-center hemodialysis (HD) and 76 patients with continuous ambulatory peritoneal dialysis (CAPD). Four alternative perspectives were applied to assess effectiveness. An additional analysis of 68 matched CAPD-HD pairs with similar characteristics was completed.
Results
Cost-effectiveness ratios (CER; cost per life-year gained) were different in alternative observation strategies. If modality changes and cadaveric transplantations were ignored, annual first three years’ CERs varied between $41220–61465 on CAPD and $44540–85688 on HD. If CAPD-failure was considered as death, CERs were $34466–81197 on CAPD. When follow-up censored at transplantation but dialysis modality changes were ignored, CERs were $59409–95858 on CAPD and $70042–85546 on HD. If observation censored at any change of primarily selected modality, figures were $57731–66710 on CAPD and $74671–91942 on HD. There was a trend of lower costs and better survival on CAPD, the only exception was the strategy in which technical failure of modality was considered as death. Figures of the matched CAPD-HD pairs were very close to the figures of the entire study population.
Conclusions
Compared to HD, CERs were slightly lower on CAPD.