Nel Henco, Debbie Fortnum, Narelle Hawkins, Sean Randall, Aron Chakera
Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Perit Dial Int. 2024 May;44(3):203-210. doi: 10.1177/08968608231190772. Epub 2023 Aug 27.
Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home.
Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed.
Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD.
This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.
辅助腹膜透析（aPD）是一种针对依赖透析的患者的替代性肾脏替代疗法，这些患者的其他选择只有长期住院或转至中心血液透析（HD）。大多数项目尚未研究临时aPD的作用，且关于临时aPD项目经济影响的数据有限。本研究的主要目的是描述辅助自动化腹膜透析（aAPD）项目的成本效益，该项目针对那些唯一的住院原因是暂时无法在家中独立进行腹膜透析的患者。
对2015年11月至2021年5月期间45例aAPD转诊病例进行回顾性单中心分析。两组患者纳入研究：已接受腹膜透析的临时替代患者（以促进出院或防止入院）和尚未接受培训的新患者（以促进出院）。为计算成本差异，将患者分配至住院或转至中心血液透析，并与aAPD的成本进行比较。从医疗保健系统角度计算aAPD辅助期间的成本。还评估了包括腹膜炎发生率、住院率和死亡率在内的临床结局。
总体而言，共提供了1349次aAPD护理。其中1042次（77%）是针对临时替代患者，307次（23%）是针对等待培训的新患者。培训前患者的平均辅助时长为18天，临时替代患者为37天。总体而言，该项目的平均住院时长为30天，范围为1至263天（标准差43），73%的患者过渡到自我护理腹膜透析。aAPD项目每次就诊成本为242美元，每位患者每次治疗平均成本为7260美元。aAPD项目比其他替代方案显著便宜，每次住院平均成本为46170美元，中心血液透析成本为9667美元。在研究过程中节省了149.7万美元。发生了11次住院，腹膜炎发生率为每位患者每年0.8次。两名患者在接受aAPD治疗期间死亡。
本研究首次详细描述了澳大利亚的aAPD临时替代项目。我们得出结论，实施临时aAPD项目可显著降低医疗成本，然而腹膜炎发生率较高。
