title: Laparoscopic versus open peritoneal dialysis catheter insertion cost analysis.
abstract: BACKGROUND
  Peritoneal dialysis (PD) is a cost-effective alternative to hemodialysis (HD). PD catheters have traditionally been inserted through a small open incision, but insertion using laparoscopic visualization has become increasingly popular and is associated with less catheter malfunction. The aim of this study was to compare costs of laparoscopic and open insertion strategies while taking into account postoperative complications and future salvage procedures.
  
  
  METHODS
  A decision analysis model was constructed to simulate 1 y outcomes after PD catheter insertion by either the open or laparoscopic approach. Possible outcomes after PD catheter placement included functional catheter, infection, and catheter malfunction. Ultimately, patients continued with successful PD or switched to HD. Baseline probabilities, costs, and ranges were determined from a critical review of the literature. Sensitivity analyses were performed to determine the model strength over a range of clinically relevant probabilities.
  
  
  RESULTS
  The total annual costs, including postoperative management and dialysis treatment, were $69,491 for laparoscopic insertion and $69,960 for open insertion. In case of a catheter malfunction, an initial attempt at salvage by fluoroscopy-guided wire manipulation cost less than a first attempt by laparoscopic repositioning.
  
  
  CONCLUSIONS
  When accounting for a year of postoperative management and treatment, laparoscopic insertion can be less costly than open insertion in the hands of an experienced surgeon. Despite higher initial costs, PD catheter insertion under laparoscopic visualization can have lower total costs due to fewer postoperative complications. With increasing emphasis on cost-effective care, laparoscopic insertion is a valuable tool for initiating PD.
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN. Electronic address: William.t.davis.1@vanderbilt.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Davis
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Dageforde
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Derek E
authors.initials: DE
authors.lastname: Moore
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D011183:Postoperative Complications / Q000517:prevention & control
keywords: Cost analysis; Laparoscopic surgery; Peritoneal dialysis