Comparison of hemodialysis and peritoneal dialysis--a cost-utility analysis.

OBJECTIVE

Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population.

DESIGN

Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective.

SETTING

All dialysis departments in the southeastern health-care region of Sweden.

PATIENTS

136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study.

MAIN OUTCOME MEASURES

Cost per life year and cost per quality-adjusted life year.

RESULTS

The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21-40 years, a 31% difference in the age group 41-60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment.

CONCLUSION

The cost-utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.