Health care costs of peritoneal dialysis technique failure and dialysis modality switching

Background: 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. Study Design: 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. Outcomes: 3-year mean adjusted total cumulative costs. Measurements: Mean direct health care costs by modality group determined using patient-level resource utilization data. Results: 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. Limitations: This analysis is taken from the perspective of the health payer, and costs that are outside the health care system are not measured. Conclusions: 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.