Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies
Abstract Introduction: Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are...
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Sociedade Brasileira de Nefrologia
2025-01-01
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| Series: | Brazilian Journal of Nephrology |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100305&lng=en&tlng=en |
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| author | Alexandre Minetto Brabo Dayana Bitencourt Dias Everton Nunes da Silva Daniela Ponce |
| author_facet | Alexandre Minetto Brabo Dayana Bitencourt Dias Everton Nunes da Silva Daniela Ponce |
| author_sort | Alexandre Minetto Brabo |
| collection | DOAJ |
| description | Abstract Introduction: Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent. Objective: To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy. Methodology: Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed. Results: At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD. Conclusion: Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries. |
| format | Article |
| id | doaj-art-34224396b4db4e779cc3f394e0d40e05 |
| institution | Kabale University |
| issn | 2175-8239 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Sociedade Brasileira de Nefrologia |
| record_format | Article |
| series | Brazilian Journal of Nephrology |
| spelling | doaj-art-34224396b4db4e779cc3f394e0d40e052025-01-21T07:35:04ZengSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology2175-82392025-01-0147110.1590/2175-8239-jbn-2024-0051enEconomic analysis of hemodialysis and urgent-start peritoneal dialysis therapiesAlexandre Minetto Brabohttps://orcid.org/0000-0001-7139-0067Dayana Bitencourt Diashttps://orcid.org/0000-0002-8687-4037Everton Nunes da Silvahttps://orcid.org/0000-0001-8747-4185Daniela Poncehttps://orcid.org/0000-0002-6178-6938Abstract Introduction: Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent. Objective: To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy. Methodology: Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed. Results: At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD. Conclusion: Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100305&lng=en&tlng=enPeritoneal DialysisHemodialysisHealth Economic EvaluationCost-Effectiveness EvaluationCost-Efficiency AnalysisHealth PolicyEvidence-Informed Policy |
| spellingShingle | Alexandre Minetto Brabo Dayana Bitencourt Dias Everton Nunes da Silva Daniela Ponce Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies Brazilian Journal of Nephrology Peritoneal Dialysis Hemodialysis Health Economic Evaluation Cost-Effectiveness Evaluation Cost-Efficiency Analysis Health Policy Evidence-Informed Policy |
| title | Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies |
| title_full | Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies |
| title_fullStr | Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies |
| title_full_unstemmed | Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies |
| title_short | Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies |
| title_sort | economic analysis of hemodialysis and urgent start peritoneal dialysis therapies |
| topic | Peritoneal Dialysis Hemodialysis Health Economic Evaluation Cost-Effectiveness Evaluation Cost-Efficiency Analysis Health Policy Evidence-Informed Policy |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100305&lng=en&tlng=en |
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