Abstract
Introduction and aims: Approximately 45,892 patients received renal replacement therapy (RRT) for end-stage renal disease (ESRD) as per the Italian Renal Registry Report 2010 report, resulting in a substantial economic burden. Published evidence suggests that peritoneal dialysis (PD) is as effective as in-center hemodialysis (ICHD) clinically. This study investigates the five-year healthcare budget impact of variable distribution of adult patients treated with PD and ICHD in Italy.
Methods: A Markov model was constructed reflecting the natural history of dialysis patients; based on this, a budget impact analysis was performed from the Italy payer perspective. We modelled a prevalent dialysis patient population over a 5-year time horizon. The current assumed Italy dialysis modality distribution (baseline: scenario 0) of 9% PD, 90% conventional ICHD, and 1% conventional home HD 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 69%, 79%, and 94% respectively. Conventional home HD (1%) was assumed to be constant across all scenarios. Model parameters and data inputs were obtained from published articles, regional registries of Lombardy, Emila Romagna and Sicily regions in Italy, and the ERA-EDTA registry.
Results: Under the current best available cost information, an increase in the prevalent PD population from 9% to 20%, and 30%, is predicted to result in five-year cumulative savings of €129 million, and €259 million, respectively. If the prevalent PD population were to decrease from 9% to 5%, the total expenditure for dialysis treatments would increase by €65 million over the next five years.
Conclusions: This analysis shows that increasing the uptake of peritoneal dialysis regimen could reduce the financial burden associated with the increasing demand for dialysis services in Italy, without compromising patient outcomes.
Background
A budget impact analysis of increasing peritoneal dialysis (PD) in Italy
- Globally, end stage renal disease (ESRD) poses a substantial and challenging health and economic burden.1,2
- The two main types of dialysis modalities are hemodialysis (HD) and peritoneal dialysis (PD).
- It is estimated that more than 2,6 million people globally were affected by ESRD at the end of 2010.3 That number included about 45,892 individuals in Italy who required dialysis in 2010.4
- Economically PD has been demonstrated to be a cost saving therapy compared to HD in most developed countries and some developing countries.5
- It is estimated that an increased uptake of PD in Italy will help generate savings.
Objective
This study investigates the five-year healthcare budget impact of variable distribution of adult patients treated with PD and ICHD in Italy.
Methods
- An Excel-based Markov model was developed using Microsoft Excel® 2010 to estimate the dialysis-associated costs assuming various dialysis modality distributions between PD and ICHD over 5 years. •The Markov model, comprised of a number of discrete health states adopts 28-day cycles (Figure 1). •Model parameters and data inputs were obtained from published articles, regional registries of Lombardy, Emila Romagna and Sicily regions in Italy, and the ERA-EDTA registry. Weighted calculations were performed appropriately (Table 1 and Table 2).
- A cohort of prevalent patients enters the model in year 1 (n=45,892). In each subsequent year, incident patients enter the model (n=10,047). •The current assumed Italy dialysis modality distribution (baseline: scenario 0) of prevalent patients of 9% PD, 90% conventional ICHD, and 1% conventional home HD 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 69%, 79%, and 94% respectively. •Conventional home HD (1%) and subsequent incident patient population distribution of 10% PD and 90% conventional ICHD was assumed to be constant across all scenarios.
Results
- Five-year cumulative results for the entire patient cohort in each scenario are presented in Figure 2 and Figure 3.
- Both scenarios (1 and 2) demonstrated lower total costs versus current Italy practice. Total costs decreased by €129 million, and €259 million, respectively.
- If the prevalent PD population were to decrease from 9% to 5%, the total expenditure for dialysis treatments would increase by €65 million over the next five years.
Conclusion
Under the current dialysis tariff, increasing the proportion of patients requiring dialysis on PD could help the Italian payer reduce dialysis associated costs, without compromising patient outcomes.