Map summarizing the HD/PD ratios in 51 countries (survey data included). where? Arranged by the year of most recently available data. The HD/PD cost ratio is 1.38 [16]. Thank you for submitting a comment on this article. Combining the three countries, there was a total of just 325 patients on PD in 2008. Please check for further notifications by email. ANGEL PERITONEAL DIALYSIS CATHETER SET NEW, Model Name/Number: DIA003 Ask Price. The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records, Cost comparison of peritoneal dialysis versus hemodialysis in end-stage renal disease, Healthcare systems and end-stage renal disease (ESRD) therapies–an international review: costs and reimbursement: funding of ESRD therapies, Cost analysis of dialysis treatments for end stage renal disease (ESRD), An economic evaluation of hospital-based hemodialysis and home-based peritoneal dialysis for pediatric patients, Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access, Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004, A cost evaluation of peritoneal dialysis and hemodialysis in the treatment of end-stage renal disease in São Paulo, Brazil, Cost/utility study of peritoneal dialysis and hemodialysis in Chile, Cost-effectiveness of interventions for end-stage renal disease, Peritonitis in peritoneal dialysis patients in Uruguay, End stage renal failure and risk factors in Peru, Peritoneal dialysis in Argentina. DIANEAL Low Calcium (2.5 mEq/L) Peritoneal Dialysis Solution 1.5% Dextrose is indicated for patients in acute or chronic renal failure. We found that these concerns were further complicated by the variability of the data compared between individual reports and by incomplete transparency. [12] in 2008 and a paper by Erek et al. (complications and non-medical economic implications were not considered in the calculations in order to avoid biased estimates). Out of the 197 000 patients on PD, ∼59% were receiving treatment in developing countries and the remaining 41% in developed countries. Australia has a PD utilization rate of nearly 23%. There are some economic reasons for this value, which is low when compared with other developed countries; one reason could be the high cost of CAPD bags. (include only basic treatment costs, basic medication costs and basic lab testing costs). The HD/PD ratio is also in favour of PD, with a value of 1.44 which was calculated from a paper by Howard et al. The health insurance does not support most patients as it is primarily meant for government officials. In Korea, the government reimburses 90% of the total cost of dialysis irrespective of the modality. Occasionally the digitization process introduces transcription errors or other problems; we are continuing to work to improve these archived versions. In 2010, an article by Abu-Aisha and Elamin [5] examined the situation of PD in Africa; there were only a few countries in which PD was cheaper than HD, while in most African countries PD is as expensive as—or more expensive than—HD. We were able to collect data from a total of eight countries. In the following, we present a brief examination of relevant factors, region by region. According to a paper by Van Bui [17] in 2008, the cost of PD may be slightly less than that of HD. This has made PD significantly less expensive than HD. However, we present some insight into some factors that might contribute to this variability. The peritoneal dialysis machines have been designed to be user-friendly and generally use similar equipment and supplies to perform APD. Thailand does not locally produce PD solutions, but is able to import solutions at low or no duty. Governments should realize that the bulk of PD costs arise from the market price of the CAPD bags. Continuous ambulatory peritoneal dialysis in Egypt: progression despite handicaps. [18] in 1998, the cost of PD was less than that of HD with a HD/PD ratio of ∼1.14. Singapore has a PD utilization rate of nearly 19%. [9] found that PD is significantly cheaper than HD in South Africa if locally manufactured solutions are used. We have made an effort to clearly differentiate between the various methodologies followed in estimating the costs by the studies we considered. This corresponds to a PD utilization rate of ∼7%. The usage of APD is higher than in most parts of the world, and due to well-structured healthcare systems, hardly any out-of-pocket payments are made towards dialysis treatment. According to the USRDS 2012 Annual Report [2], the annual per patient cost of HD is ∼USD 87 500 per year, while that of PD is ∼USD 66 750. Table 3 is the final list of our estimates of HD/PD cost ratios in 46 countries. For these reasons, such measurement errors deriving from heterogeneous methodologies (which are quite possibly present in this literature) do not invalidate our conclusion that PD is overall more cost-effective than HD. A summary of all papers, including the estimate of HD/PD cost ratios, year of publication and type of methodology, is provided in Table 1. The HD/PD ratio is ∼1.03 [10], indicating that HD and PD cost nearly the same. The overall dialysis rates can be as low as 24 in India and as high as 2323 in Taiwan. Sources for manufacturing and duties: Baxter. Let us take transportation costs as an example: an HD patient is required to travel to a clinic or a hospital 13 times a month on average, while a PD patient does not need to travel as often. The three categories resulting from these considerations are: cost-benefit analyses, cost-effectiveness analyses or cost-utility analyses; cost identification analyses or synthesis studies or calculation of yearly cost using basic treatment only; reimbursement given for the therapy depending on standard tariffs. PD solutions are imported and the duty is high. Health Expenditure Indicators (, 2012. Published by Oxford University Press on behalf of ERA-EDTA. Given that solutions are often imported, PD is more expensive than HD in most countries, and PD utilization rates are very low, with the exception of South Africa. "It can do the job and it works at night without supervision.". Most countries in Africa are very new users of PD. Since 1995, CAPD use in Iran has been steadily increasing. Before you receive a cycler, you will go through peritoneal dialysis training with a PD nurse. Post a free Request For Proposal for a BAXTER PD Peritoneal Dialysis Machine and get quotes from our Gold Service Dealers. Various obstacles to peritoneal dialysis development in Japan: too much money? The total number of PD patients in 2008 was 1198, making up roughly 5.5% of all dialysis patients [1]. Only a few patients in these countries are reimbursed and that too by private insurance companies. For this reason, any possible bias deriving from the measurement error in costs is likely to underestimate—and not overestimate—the cost advantage of PD over HD. Its cost is expected to be about half the $20,000 to $35,000 a year that traditional dialysis costs, because it does not require doctors, nurses and the overhead costs of clinics, company executives said. This approach, which was followed by Just et al. Overall PMP and PMP of HD patients were calculated using the PD utilization and PD PMP data. Baxter, which derives $1 billion of its $9 billion in annual revenue from dialysis machines and chemicals, pioneered home peritoneal dialysis. The peritoneal membrane, which lines the cavity, filters wastes from the blood and transfers them to the fluid. In Figure 3, we show that in countries with access to low-cost PD equipment—either through local manufacturing or through low import duties—PD is on average significantly less expensive than HD (see figures for data source references). Baxter, which derives $1 billion of its $9 billion in annual revenue from dialysis machines and chemicals, pioneered home peritoneal dialysis. Again, this factor will lead to lower estimates for the overall cost ratio. In this respect, an assessment limited to basic costs only will result in lower estimate of the difference between PD and HD costs. On average, HD in Europe is significantly more expensive (by 30–60%) than PD. © The Author 2013. Too much fear? 2011. On average, this group of countries has an overall dialysis PMP of 377 (280 HD and 97 PD) and therefore a high PD utilization rate of 26% [7]. Code used for APD usage: 1 ≤ 12.5%, 2 = 12.5–25%, 3 = 25–37.5%, 4 = 37.5–50%, 5 ≥ 50%. [Cost of peritoneal dialysis and hemodialysis in limited care facilities in Italy], Valutazione dei costi dei trattamenti dialitici. In all 19 surveys (10 were completed) were sent out to nephrologists in China (1/1), South Korea (1/1), Taiwan (1/1), Bangladesh (2/2), Thailand (1/1), Nepal (1/1), Argentina (2/2), El Salvador (1/1), Colombia (0/2), Guatemala (0/1), Indonesia (0/1), Poland (0/1), Hungary (0/1), Russia (0/1), Portugal (0/1) and Slovenia (0/1) (number of completed surveys/number of surveys sent). DIANEAL Low Calcium Peritoneal Dialysis Solution 1.5% Dextrose, AMBU-FLEX II Container with yellow pull ring, 2000 mL. Hemodialysis Hemodialysis is the predominant therapy for end-stage kidney disease, and … Peritoneal dialysis (PD) as a modality is underutilized in most parts of the world today despite several advantages including the possibility of it being offered in the remotest of locations and being significantly more affordable than haemodialysis (HD) in most cases. A nationwide study, Policies and health care financing issues for dialysis in Latin America: extracts from the roundtable discussion on the economics of dialysis and chronic kidney disease, The economic cost of dialysis: a comparison between peritoneal dialysis and in-center hemodialysis in a Spanish unit, Cost analysis of the Spanish renal replacement therapy programme, Cost-effectiveness analysis of renal replacement therapy in Austria, Prevalence and direct medical costs of end-stage renal disease in patients with type 2 diabetes mellitus in Switzerland for 2001, The cost of dialysis and kidney transplantation in France in 2007, impact of an increase of peritoneal dialysis and transplantation [French], Enquête sur la dialyse rénale. Our final calculations included 46 countries (20 developed and 26 developing). (r and P result from Pearson's correlations). A sterile fluid that is mostly sugar water is pumped into the abdominal cavity through tubes. Homechoice "seems to be an effective and valuable addition to what is available to patients," Dr. Garabed Eknoyan, a member of the board of the National Kidney Foundation, said. In France and Germany, the reimbursement for HD is significantly higher than the reimbursement for PD, while in Italy the reimbursement does not vary with the modality. Boxplot of the HD/PD cost ratio across two groups of countries. For each country, we will also report the PD utilization rate, APD usage, PD per million population (PMP) rate and number of PD patients in 2008. In 2008, there were ∼1.75 million patients worldwide who regularly received renal replacement therapy in the form of dialysis, of which 89% or ∼1.55 million were on haemodialysis (HD) and ∼11% or ∼197 000 patients were on peritoneal dialysis (PD). Numbers or symptoms: when to initiate dialysis? A total of 79 articles were finally included in our study. Correspondence and offprint requests to: Claudio Ronco; E-mail: Search for other works by this author on: Department of Nephrology, Dialysis and Transplantation, Global trends in rates of peritoneal dialysis, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States Retrieved (18 December 2012), Economic evaluations of dialysis treatment modalities, The cost barrier to peritoneal dialysis in the developing world—an Asian perspective, Impact of initial dialysis modality and modality switches on medicare expenditures of end-stage renal disease patients, Latin American dialysis and renal transplantation registry: 2008 report (data 2006), Africa and nephrology: the forgotten continent, Peritoneal dialysis in Cape Town, South Africa, Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia, The story of continuous ambulatory peritoneal dialysis in Iran, Cost of renal replacement therapy in Turkey.

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