title: More Use of Peritoneal Dialysis Gives Significant Savings: A Systematic Review and Health Economic Decision Model.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) are in need of renal replacement therapy as dialysis and/or transplantation. The prevalence of ESRD and, thus, the need for dialysis are constantly growing. The dialysis modalities are either peritoneal performed at home or hemodialysis (HD) performed in-center (hospital or satellite) or home. We examined effectiveness and cost-effectiveness of HD performed at different locations (hospital, satellite, and home) and peritoneal dialysis (PD) at home in the Norwegian setting.
  
  
  METHODS
  We conducted a systematic review for patients above 18 years with end-stage renal failure requiring dialysis in several databases and performed several meta-analyses of existing literature. Mortality and major complications that required were our main clinical outcomes. The quality of the evidence for each outcome was evaluated using GRADE. Cost-effectiveness was assessed by developing a probabilistic Markov model. The analysis was carried out from a societal perspective, and effects were expressed in quality-adjusted life-years. Uncertainties in the base-case parameter values were explored with a probabilistic sensitivity analysis. Scenario analyses were conducted by increasing the proportion of patients receiving PD with a corresponding reduction in HD patients in-center both for Norway and Europian Union. We assumed an annual growth rate of 4% in the number of dialysis patients, and a relative distribution between PD and HD in-center of 30% and 70%, respectively.
  
  
  RESULTS
  From a societal perspective and over a 5-year time horizon, PD was the most cost-effective dialysis alternative. We found no significant difference in mortality between peritoneal and HD modalities. Our scenario analyses showed that a shift toward more patients on PD (as a first choice) with a corresponding reduction in HD in-center gave a saving over a 5-year period of 32 and 10,623 million EURO, respectively, for Norway and the European Union.
  
  
  CONCLUSIONS
  PD was the most cost-effective dialysis alternative and was comparable with HD regarding efficacy outcomes. There are significant saving potentials if more end-stage renal patients are started on PD instead of HD.
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Pike
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Vida
authors.initials: V
authors.lastname: Hamidi
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Tove
authors.initials: T
authors.lastname: Ringerike
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacology, University of Oslo, Norway.
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Wisloff
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacology, University of Oslo, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Klemp
keywords: Dialysis; Health economics; Hemodialysis; Peritoneal