Continuous ambulatory peritoneal dialysis costs less than other modalities in the UK
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Compared with other dialysis modalities in the United Kingdom, continuous ambulatory peritoneal dialysis appeared to be less costly between 2018 and 2019, according to data published in Peritoneal Dialysis International.
Further, when ambulance transport was included, automated PD and home-based hemodialysis were less expensive than unit-based dialysis.
“Dialysis is a relatively high-cost treatment, with previous commentators estimating that the U.K. [National Health Service] NHS spends over £500 million per year on dialysis,” Gareth Roberts, PhD, a nephrologist at the department of nephrology at Aneurin Bevan University Health Board in Wales, and colleagues wrote. They added, “Our aim in the current study was to undertake a top-down and bottom-up methods costing study, working with the [Welsh Renal Clinical Network] WRCN and managers/clinicians from each of the individual renal units in Wales so that we could compare directly the costs of home and unit-based dialysis to provide a comprehensive and costed model of different options to inform decision-making in the United Kingdom.”
In a comprehensive analysis study, researchers applied hybrid top-down and bottom-up cost methods to measure the direct medical costs of dialysis modalities across Wales. The commissioners of service and interviewed renal consultants, nurses, accounts, managers and allied health care professionals provided micro-cost data. Additionally, the WRCN and Welsh Ambulance Service Trust provided top-down cost information.
Evaluations revealed the annual direct cost per patient for home-based modalities was £16,395 for continuous ambulatory peritoneal dialysis (CAPD), £20,295 for automated PD and £23,403 for home-based hemodialysis. When it came to unit-based modalities, the annual cost per patient depended on whether the patient used ambulance transport. Ambulance transport increased the cost of dialysis for satellite units run in partnership with independent sector providers from £19,990 to £28,931, and increased hospital units managed and staffed by the NNH from £23,737 to £32,678.
“This detailed analysis combines micro-costing, local and regional costing data (including both NHS and independent sector costing and transport costs), and as such is the most comprehensive costing study of dialysis modalities undertaken to date in a publicly funded health care system. The results showed that nearly two dialysis patients could be treated at home via CAPD for approximately the same cost as one patient requiring transport and treated in an NHS hospital dialysis unit,” Roberts and colleagues wrote. They added, “As our study provides new and comprehensive data on the costs of each of the different components that contribute to the overall costs of dialysis, it will better enable health care systems, and in particular commissioners to model the costs of service re-design, as well as inform future cost-effectiveness studies and clinical guidelines.”
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