title: Economic evaluation of urgent-start peritoneal dialysis versus urgent-start hemodialysis in the United States.
abstract: Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization. However, there has been no assessment of the dialysis-related costs over the first 90 days of care. The objective of this study was to characterize the costs associated with urgent-start PD, urgent-start hemodialysis (HD), or a dual approach (urgent-start HD followed by urgent-start PD) over the first 90 days of treatment from a provider perspective. A survey of practitioners from 5 clinics known to use urgent-start PD was conducted to provide inputs for a cost model representing typical patients. Model inputs were obtained from the survey, literature review, and available cost data. Sensitivity analyses were also conducted. The estimated per patient cost over the first 90 days for urgent-start PD was $16,398. Dialysis access represented 15% of total costs, dialysis services 48%, and initial hospitalization 37%. For urgent-start HD, total per patient costs were $19,352, and dialysis access accounted for 27%, dialysis services 42%, and initial hospitalization 31%. The estimated cost for dual patients was $19,400. Urgent-start PD may offer a cost saving approach for the initiation of dialysis in eligible patients requiring an urgent-start to dialysis.
authors.affiliation: From the Healthcare Economics International, Baxter Healthcare Corporation, Deerfield, IL 60015, USA (FXL); Division of Nephrology, University of Southern California, 2020 Zonal Ave, IRD 806, Los Angeles, CA 90033, USA (AG); Pharmerit International, 4350 East-West Highway, Suite 430, Bethesda, MD 20814, USA (HD); Southwest Kidney Institute, PLC, 2149 E Warner Road, Tempe, AZ 85284, USA (VK); Kidney Disease and High Blood Pressure Clinic, 510 Vonderburg Rd. Suite 208, Brandon, FL 33511, USA (CB); University of Alabama, 230 Paula Building, 728 Richard Arrington Blvd, Birmingham, AL 35294, USA (EW); St. Clair Specialty Physicians, 22201 Moross Road PB#2, Suite 150, Detroit, MI 48236, USA (QK); Pharmerit International, 4350 East-West Highway, Suite 430, Bethesda, MD 20814, USA (BL); Pharmerit International, 4350 East-West Highway, Suite 430, Bethesda, MD 20814, USA (XG); St. Clair Specialty Physicians, PC, 22201 Moross Road PB#2, Suite 150, Detroit, MI 48236, USA (HH); St. Clair Specialty Physicians, 22201 Moross Road PB#2 Suite 150, Detroit, MI 48236, USA (PL); DaVita USC Kidney Center, 2310 Alcazar St, Los Angeles, CA 90033, USA (EMD); DaVita USC Kidney Center, 2310 Alcazar St, Los Angeles, CA 90033, USA (MMA); Tempe Home Program, 2149 E Warner Rd Suite 109, Tempe, AZ 85284, USA (JH); Tempe Home Program, 2149 E Warner Rd, Suite 109, Tempe, AZ 85284, USA (MM); Department of Pharmacy Systems, Outcomes, and Policy, 833 S. Wood Street (M/C 871), Chicago, IL 60612, USA (SW); and Baxter Healthcare Corporation, Deerfield, IL 60015, USA (SG).
authors.forename: Frank Xiaoqing
authors.initials: FX
authors.lastname: Liu
authors.forename: Arshia
authors.initials: A
authors.lastname: Ghaffari
authors.forename: Harman
authors.initials: H
authors.lastname: Dhatt
authors.forename: Vijay
authors.initials: V
authors.lastname: Kumar
authors.forename: Cristina
authors.initials: C
authors.lastname: Balsera
authors.forename: Eric
authors.initials: E
authors.lastname: Wallace
authors.forename: Quresh
authors.initials: Q
authors.lastname: Khairullah
authors.forename: Beth
authors.initials: B
authors.lastname: Lesher
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.forename: Heather
authors.initials: H
authors.lastname: Henderson
authors.forename: Paula
authors.initials: P
authors.lastname: LaFleur
authors.forename: Edna M
authors.initials: EM
authors.lastname: Delgado
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Alvarez
authors.forename: Janett
authors.initials: J
authors.lastname: Hartley
authors.forename: Marilyn
authors.initials: M
authors.lastname: McClernon
authors.forename: Surrey
authors.initials: S
authors.lastname: Walton
authors.forename: Steven
authors.initials: S
authors.lastname: Guest
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics* / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics* / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States