title: Budget Impact Analysis of Peritoneal Dialysis versus Conventional In-Center Hemodialysis in Malaysia.
abstract: OBJECTIVE
  To investigate the 5-year health care budget impact of variable distribution of adult patients treated with peritoneal dialysis (PD) and in-center hemodialysis (ICHD) on government funding in Malaysia.
  
  
  METHODS
  An Excel-based budget impact model was constructed to assess dialysis-associated costs when changing dialysis modalities between PD and ICHD. The model incorporates the current modality distribution and accounts for Malaysian government dialysis payments and erythropoiesis-stimulating agent costs. Epidemiological data including dialysis prevalence, incidence, mortality, and transplant rates from the Malaysian renal registry reports were used to estimate the dialysis patient population for the next 5 years. The baseline scenario assumed a stable distribution of PD (8%) and ICHD (92%) over 5 years. Alternative scenarios included the prevalence of PD increasing by 2.5%, 5.0%, and 7.5% or decreasing 1% yearly over 5 years. All four scenarios were accompanied with commensurate changes in ICHD.
  
  
  RESULTS
  Under the current best available cost information, an increase in the prevalent PD population from 8% in 2014 to 18%, 28%, or 38% in 2018 is predicted to result in 5-year cumulative savings of Ringgit Malaysia (RM) 7.98 million, RM15.96 million, and RM23.93 million, respectively, for the Malaysian government. If the prevalent PD population were to decrease from 8% in 2014 to 4.0% by 2018, the total expenditure for dialysis treatments would increase by RM3.19 million over the next 5 years.
  
  
  CONCLUSIONS
  Under the current cost information associated with PD and HD paid by the Malaysian government, increasing the proportion of patients on PD could potentially reduce dialysis-associated costs in Malaysia.
authors.affiliation: Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. Electronic address: sbavanandan@gmail.com.
authors.forename: Sunita
authors.initials: S
authors.lastname: Bavanandan
authors.affiliation: Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Ghazali
authors.initials: G
authors.lastname: Ahmad
authors.affiliation: Baxter Healthcare (M) Sdn Bhd, Kuala Lumpur, Malaysia.
authors.forename: Ai-Hong
authors.initials: AH
authors.lastname: Teo
authors.affiliation: Baxter Healthcare Ltd., Shanghai, China.
authors.forename: Lilian
authors.initials: L
authors.lastname: Chen
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL, USA.
authors.forename: Frank Xiaoqing
authors.initials: FX
authors.lastname: Liu
mesh_terms: D002017:Budgets; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008296:Malaysia; D010530:Peritoneal Dialysis / Q000191:economics*; D006435:Renal Dialysis
keywords: budget impact; in-center hemodialysis; peritoneal dialysis