FP589A COST EFFECTIVENESS ANALYSIS OF PERITONEAL DIALYSIS VERSUS IN-CENTER HEMODIALYSIS IN ITALY

Abstract

Introduction and Aims: An analysis of the recent scientific literature shows that peritoneal dialysis (PD) is cost effective compared to thrice weekly conventional in-center hemodialysis (ICHD). However, such cost effectiveness has never been conducted from Italian payer perspective. The aim of this study was to estimate the benefits and costs associated with different hypothetical scenarios of dialysis ratio of PD/ICHD vs. the current situation of 10% PD vs. 90% conventional ICHD in Italy. Methods: We constructed an Excel-based Markov model to estimate the costs and quality adjusted life years (QALYs) associated with different modality distributions from the Italian payer's perspective. We modeled an incident dialysis patient population over a time horizon of 5 and 10 years. The current Italy dialysis modality distribution (scenario 0) of 10% PD and 90% conventional ICHD, was compared to 3 hypothetical scenarios: Scenario 1: 30% PD; Scenario 2: 20% PD; Scenario 3: 5% PD. In all scenarios, the percentage of ICHD changed accordingly to 70%, 80%, and 95% respectively. Model parameters and data inputs were obtained from published articles, the Lombardy Registry of Dialysis and Transplantation (RLDT), and the ERA-EDTA registry. All future costs and benefits were discounted to their present value at an annual rate of 3.0%. Results: The number of incident dialysis patients was estimated to be 11,809 in Italy in 2010. Scenarios 1 (30% PD) and 2 (20% PD) demonstrate lower costs and higher QALYs compared to Scenario 0 (10% PD), whereas opposite findings were seen for Scenario 3 (5% PD) compared to Scenario 0. Increasing PD to 20% saves between €3,942-4,795 per patient and results in an increase of 0.013-0.014 QALYs per patient over 5 to 10 years. Increasing PD to 30% saves between €7,884-9,591 per patient and results in an increase of 0.025-0.027 QALYs per patient over 5 to 10 years. Reducing the PD use to 5% results in an increase of costs between €1,971-2,397 per patient and a decrease in QALY between 0.006-0.007 per patient. Conclusions: Our study indicates that increasing the use of PD from 10% to 20 or 30% among incident Italian ESRD patients might generate healthcare savings while improving health benefits. However, decreasing the use of PD from 10% to 5% might increase healthcare costs and unfavorably impact health outcomes These results are consistent with the published literature in other countries.