Economic impact of extended time on peritoneal dialysis as a result of using polyglucose: the application of a Markov chain model to forecast changes in the development of the ESRD programme over time

• Published in: Nephrology, dialysis, transplantation Vol. 18; no. 2; pp. 390 - 396
• Main Authors: Weijnen, Tom J. G., van Hamersvelt, Henk W., Just, Paul M., Struijk, Dick G., Tjandra, Yuvan I., ter Wee, Piet M., de Charro, Frank Th
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2003
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Dialysis Solutions - therapeutic use; economic evaluation; Emergency and intensive care: renal failure. Dialysis management; extended time on treatment; Glucans - therapeutic use; Health Care Costs; Humans; Infant; Infant, Newborn; Intensive care medicine; Kidney Failure, Chronic - therapy; Markov chain modelling; Markov Chains; Medical sciences; Middle Aged; peritoneal dialysis; Peritoneal Dialysis - economics; Peritoneal Dialysis - methods; polyglucose; Program Development; Time Factors; Human; Extrarenal dialysis; Economic analysis; Osmolarity; Dialysis fluid; Duration; economic evaluation; Cost analysis; extended time on treatment; polyglucose; Peritoneal dialysis; Markov chain modelling
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/18.2.390

Background. The use of polyglucose as a peritoneal dialysis (PD) fluid extends time on PD treatment. It is anticipated, therefore, that the share of patients treated with PD will be positively influenced. The relationship between extension of PD treatment time and an increase of the PD treatment share, however, is complex and needs further investigation. In this paper, a Markov chain model was applied to investigate the impact of extended time on PD treatment for the PD share in all dialysis patients in The Netherlands. Furthermore, the economic impact of the extended time on treatment (ETOT) was explored. Methods. Scenarios were forecast over a 10 year period using aggregate data from the End‐Stage Renal Registry in The Netherlands (Renine). Three scenarios were simulated in which the median PD technique survival was extended by 8, 10 and 12 months. Two other scenarios explored the impact of the combined effect of ETOT of 10 months together with a 10% and 20% increase of PD inflow shares. Reductions of costs to society due to ETOT were estimated using Dutch cost data on renal replacement therapies. Results. PD share increases from 30.0% in the null scenario to 34.5% in the scenario with an ETOT of 10 months and an increased PD inflow share of 20%. The reduction in total costs to society of the renal replacement therapies is 0.96%. The average societal costs per discounted patient year for haemodialysis (HD) are €84 100. For PD, these costs are €60 300. A shift from HD to PD results in average cost savings of 28% per patient year. Conclusions. In view of high dialysis costs to society, a reduction of 0.96% can be considered to be relevant for healthcare policy makers.