title: Gaining efficiencies: resources and demand for dialysis around the globe.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) is a debilitating condition resulting in death unless treated. Treatment options are transplantation and dialysis. Alternative dialysis modalities are peritoneal dialysis (PD) and hemodialysis (HD), each of which has been shown to produce similar outcomes and survival. Nevertheless, the financial implications of each modality are different and these differences vary by country, especially in the developing world. Changes in clinically appropriate dialysis delivery leading to more efficient use of resources would increase the resources available to treat ESRD or other disabling conditions. This article outlines the relative advantages of HD and PD and uses budget impact analysis to estimate the country-specific, 5-year financial implications on total dialysis costs assuming utilization shifts from HD to PD in two high-income (UK, Singapore), three upper-middle-income (Mexico, Chile, Romania), and three lower-middle-income (Thailand, China, Colombia) countries.
  
  
  RESULTS
  Peritoneal dialysis is a clinically effective dialysis option that can be significantly cost-saving compared to HD, even in developing countries.
  
  
  CONCLUSIONS
  The magnitude of costs associated with treating ESRD patients globally is large and growing. PD is a clinically effective dialysis option that can be used by a majority of ESRD patients and can also be significantly cost-saving compared to HD therapy. Increasing clinically appropriate PD use would substantially reduce health-care costs and help health-care systems meet ever-tightening budget constraints.
authors.affiliation: Lifecycle Sciences Group, ICON Clinical Research, San Francisco, CA 94105, USA. nneil@ovation.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Neil
authors.forename: David R
authors.initials: DR
authors.lastname: Walker
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sesso
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Blackburn
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Tschosik
authors.forename: Vito
authors.initials: V
authors.lastname: Sciaraffia
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Contreras
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Capsa
authors.forename: Samir K
authors.initials: SK
authors.lastname: Bhattacharyya
mesh_terms: D003362:Cost-Benefit Analysis; D019049:Developed Countries / Q000191:economics; D003906:Developing Countries / Q000191:economics; D014943:Global Health; D006295:Health Resources; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D010530:Peritoneal Dialysis / Q000191:economics*; D006435:Renal Dialysis / Q000191:economics