title: Economic impact of extended time on peritoneal dialysis as a result of using polyglucose: the application of a Markov chain model to forecast changes in the development of the ESRD programme over time.
abstract: BACKGROUND
  The use of polyglucose as a peritoneal dialysis (PD) fluid extends time on PD treatment. It is anticipated, therefore, that the share of patients treated with PD will be positively influenced. The relationship between extension of PD treatment time and an increase of the PD treatment share, however, is complex and needs further investigation. In this paper, a Markov chain model was applied to investigate the impact of extended time on PD treatment for the PD share in all dialysis patients in The Netherlands. Furthermore, the economic impact of the extended time on treatment (ETOT) was explored.
  
  
  METHODS
  Scenarios were forecast over a 10 year period using aggregate data from the End-Stage Renal Registry in The Netherlands (Renine). Three scenarios were simulated in which the median PD technique survival was extended by 8, 10 and 12 months. Two other scenarios explored the impact of the combined effect of ETOT of 10 months together with a 10% and 20% increase of PD inflow shares. Reductions of costs to society due to ETOT were estimated using Dutch cost data on renal replacement therapies.
  
  
  RESULTS
  PD share increases from 30.0% in the null scenario to 34.5% in the scenario with an ETOT of 10 months and an increased PD inflow share of 20%. The reduction in total costs to society of the renal replacement therapies is 0.96%. The average societal costs per discounted patient year for haemodialysis (HD) are 84 100 euros. For PD, these costs are 60 300 euros. A shift from HD to PD results in average cost savings of 28% per patient year.
  
  
  CONCLUSIONS
  In view of high dialysis costs to society, a reduction of 0.96% can be considered to be relevant for healthcare policy makers.
authors.affiliation: Centre for Health Policy and Law, Erasmus University Rotterdam, PO Box 1738, NL-3000 DR Rotterdam, The Netherlands. weijnen@frg.eur.nl
authors.forename: Tom J G
authors.initials: TJ
authors.lastname: Weijnen
authors.forename: Henk W
authors.initials: HW
authors.lastname: van Hamersvelt
authors.forename: Paul M
authors.initials: PM
authors.lastname: Just
authors.forename: Dick G
authors.initials: DG
authors.lastname: Struijk
authors.forename: Yuvan I
authors.initials: YI
authors.lastname: Tjandra
authors.forename: Piet M
authors.initials: PM
authors.lastname: ter Wee
authors.forename: Frank Th
authors.initials: FT
authors.lastname: de Charro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005936:Glucans / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008390:Markov Chains; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics* / Q000379:methods*; D016730:Program Development; D013997:Time Factors
chemical_list: D015314:Dialysis Solutions; D005936:Glucans