title: Comparison of cost-utility between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis.
abstract: OBJECTIVE
  The use of automated peritoneal dialysis (APD) is increasing compared to continuous ambulatory peritoneal dialysis (CAPD). Surprisingly, little data about health benefits and cost of APD exist, and virtually no information comparing the cost-utility between CAPD and APD is available. We undertook this study to evaluate and compare the health-related quality of life (HRQOL) and cost-utility indexes in patients on CAPD vs.
  This was a prospective cohort of patients initiating dialysis (2008-2009). Two questionnaires were self-administered: European Research Questionnaire Quality of Life (EQ-5D) and Kidney Disease Quality of Life (short form, KDQOL-SF, Rand, Santa Monica, CA). Direct medical costs (DMC) were determined from the health provider perspective including the following medical resource utilization: outpatient clinic/emergency care, dialysis procedures, medications, laboratory tests, hospitalization, and surgery. Cost-utility indexes were calculated dividing total mean cost by indicators of the HRQOL.
  
  
  RESULTS
  One hundred twenty-three patients were evaluated: 77 on CAPD and 46 on APD. Results of the EQ-5D and KDQOL-SF questionnaires were significantly better in APD compared to the CAPD group. Main costs in both APD and CAPD were attributed to hospitalization and dialysis procedures followed by medication and surgery. Outpatient clinic visits and laboratory tests were significantly more costly in CAPD than in APD, whereas dialysis procedures were more expensive in the latter. Cost-utility indexes were significantly better in APD compared to CAPD.
  
  
  CONCLUSIONS
  A significant cost-utility advantage of APD vs. CAPD was observed. The annual DMC per-patient were not different between groups but the HRQOL was better in the APD compared to the CAPD group.
authors.affiliation: Medical Research Unit in Kidney Diseases, Specialties Hospital, CMNO, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico. Electronic address: cortes_sanabria@yahoo.com.mx.
authors.forename: Laura
authors.initials: L
authors.lastname: Cortés-Sanabria
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Paredes-Ceseña
authors.forename: Rebeca M
authors.initials: RM
authors.lastname: Herrera-Llamas
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Cruz-Bueno
authors.forename: Herman
authors.initials: H
authors.lastname: Soto-Molina
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pazarín
authors.forename: Margarita
authors.initials: M
authors.lastname: Cortés
authors.forename: Héctor R
authors.initials: HR
authors.lastname: Martínez-Ramírez
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D001331:Automation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D010530:Peritoneal Dialysis / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Automated peritoneal dialysis; Continuous ambulatory peritoneal dialysis; Cost-utility index; Direct medical costs; Quality of life; Utilities