title: Offering assisted peritoneal dialysis is a cost-effective alternative to the current care pathway in frail elderly Dutch patients.
abstract: BACKGROUND
  With the Dutch population aging, the number of individuals 75 years old or more needing dialysis is growing. This analysis assessed the cost-effectiveness of adding nurse-assisted peritoneal dialysis (aPD) to the usual care pathway in frail Dutch end-stage renal disease (ESRD) patients.
  
  
  METHODS
  THE CURRENT DUTCH TREATMENT PATHWAY (CONSERVATIVE MANAGEMENT, CM: 40% and PD in nursing home, nhPD: 60%) was compared in a decision-tree model with a new approach where the proportion of patients on dialysis would increase to 80% (i.e. CM: 20%; nhPD: 20%; and aPD: 60%). In-center hemodialysis was added in a secondary analysis. Inputs included survival (from literature), utility (from literature), and costs (2009 official tariffs). A healthcare payer's perspective was used with a 5-year horizon.
  
  
  RESULTS
  The new approach was almost cost neutral in the primary analysis (despite more patients on dialysis) and dominant (more effective and less expensive) in the secondary analysis. The incremental cost-effectiveness ratio was only €52/QALY. In the sensitivity analyses (primary and secondary analyses), the new approach was either dominant or cost-effective in approximately 75% of the simulations.
  
  
  CONCLUSIONS
  Despite the investment required, offering aPD to frail elderly ESRD patients is a cost-effective alternative to the current pathway for Dutch healthcare payers.
authors.affiliation: EMEA Health Outcomes, Baxter Healthcare Corporation, Brussels, Belgium.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Laplante
authors.affiliation: Sint Franciscus Ziekenhuis, Roosendaal, the Netherlands.
authors.forename: Harmen
authors.initials: H
authors.lastname: Krepel
authors.affiliation: Sint Franciscus Ziekenhuis, Roosendaal, the Netherlands.
authors.forename: Bregje
authors.initials: B
authors.lastname: Simons
authors.affiliation: Baxter Healthcare Corporation, Utrecht, the Netherlands.
authors.forename: Aafke
authors.initials: A
authors.lastname: Nijhoff
authors.affiliation: Healthcare Management School, Amersfoort, the Netherlands.
authors.forename: Rens
authors.initials: R
authors.lastname: van Liere
authors.affiliation: Baxter Healthcare Corporation, Utrecht, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Simons
keywords: Assisted peritoneal dialysis; Cost-effectiveness; Dialysis; Elderly; End-stage renal disease; Home treatment