Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Am J Kidney Dis. 2013 Jan;61(1):104-11. doi: 10.1053/j.ajkd.2012.07.010. Epub 2012 Aug 15.
Although there is a strong economic rationale in favor of peritoneal dialysis (PD) over hemodialysis (HD), the potentially costly effect of PD technique failure is an important consideration in PD program promotion that is unknown.
Incident dialysis patients were categorized by initial and subsequent modality changes during the first year of dialysis and tracked for inpatient and outpatient costs, physician claims, and medication costs for 3 years using merged administrative data sets. We determined unadjusted and adjusted total cumulative costs for each modality group using multivariable linear regression models.
SETTING & PARTICIPANTS: All incident dialysis patients from Alberta in 1999-2003.
3-year mean adjusted total cumulative costs.
Mean direct health care costs by modality group determined using patient-level resource utilization data.
3-year adjusted total cumulative costs for patients in the PD-only and HD-to-PD groups were $58,724 (95% CI, $44,123-$73,325) and $114,503 (95% CI, $96,318-$132,688), respectively, compared with $175,996 (95% CI, $134,787-$217,205) for HD only. PD technique failure was associated with lower costs by $11,466 (95% CI, $248-$22,964) at 1 year compared with HD only; however, costs were similar at 3 years. Costs drivers in PD technique failure arose primarily from costs of dialysis provision, hospitalization, medications, and physician fees.
This analysis is taken from the perspective of the health payer, and costs that are outside the health care system are not measured.
Compared with patients who receive only HD, those who received PD only and those who transitioned from HD to PD therapy had significantly lower total health care costs at 1 and 3 years. Patients experiencing PD technique failure had costs similar and not in excess of HD-only patients at 3 years, further supporting the economic rationale for a PD-first policy in all eligible patients.
尽管腹膜透析（PD）相对于血液透析（HD）具有强大的经济理论依据，但 PD 技术失败的潜在昂贵影响是 PD 计划推广中一个重要的考虑因素，目前尚不清楚。
在透析开始后的第一年，根据初始和随后的治疗模式变化，将接受透析的患者分为不同类别，并使用合并的行政数据集跟踪患者 3 年内的住院和门诊费用、医生索赔和药物费用。我们使用多变量线性回归模型确定了每个治疗模式组的未经调整和调整后的总累积成本。
1999 年至 2003 年艾伯塔省所有接受透析的患者。
3 年平均调整后的总累积成本。
使用患者水平的资源利用数据确定每个治疗模式组的平均直接医疗保健费用。
PD 组和 HD 转 PD 组的 3 年调整后总累积成本分别为 58724 加元（95%CI，44123-73325 加元）和 114503 加元（95%CI，96318-132688 加元），而 HD 组的总累积成本为 175996 加元（95%CI，134787-217205 加元）。与仅接受 HD 治疗的患者相比，PD 技术失败患者在第 1 年的成本降低了 11466 加元（95%CI，248-22964 加元），但在第 3 年时，两组成本相近。PD 技术失败的成本驱动因素主要来自透析提供、住院、药物和医生费用。
本分析从医疗保健支付方的角度出发，并未测量医疗保健系统之外的成本。
与仅接受 HD 治疗的患者相比，仅接受 PD 治疗和从 HD 转 PD 治疗的患者在第 1 年和第 3 年的总医疗保健费用显著降低。PD 技术失败的患者在第 3 年的成本与仅接受 HD 治疗的患者相似，并未超出 HD 治疗患者，这进一步支持了对所有符合条件的患者采用 PD 优先政策的经济理论依据。
