Videolaparoscopy is the gold standard for the revision of persistent malfunctioning peritoneal catheters. The surgical intervention aims to regain effective catheter function in order to proceed with peritoneal dialysis (PD).
The aim of the study is to analyse the cost-effectiveness of videolaparoscopic interventions based on reimbursement costs.
Reimbursement costs of catheter malfunction management, based on diagnoses related groups and out-patient interventions of the Italian national health system, are calculated for the following two simulations: Hospitalisation for videolaparoscopic revision and follow up in APD versus termination of PD, placement of a temporary central venous catheter, creation of an arterio-venous fistula and in-centre haemodialysis (HD). The break-even point of the two strategies, indicating the time after intervention at equivalence of costs, is estimated.
Videolaparoscopic interventions for catheter malfunction, performed between 2002 and 2011, were analysed and followed up to 2012.
The break-even point of the two strategies was determined at 36 weeks after intervention.
Forty three revisions have been performed. Twelve patients were still on PD at the end of the observation (prolongation of function: median 87 weeks), whereas the remaining 31 cases terminated PD in median 43 weeks after revision. The total number of weeks remaining on PD was 4068 weeks, in confront to 1548 weeks (43 cases x 36 weeks) needed to reach break-even. Theoretical savings amount to 284.760 Euro. This is equivalent to annual dialysis costs of 14 patients in APD, respectively 16 patients in CAPD.
PD is generating a minor costs in confront to HD from the view point of the national health system. The need of videolaparoscopic revision annuls this economic advantage. A cost-effective intervention has to result in a prolongation of catheter function and stay on PD of at least 36 weeks. The retrospective analysis of our videolaparoscopy program confirms cost-effectiveness of the procedure.
