Videolaparoscopy is the gold standard for the revision of persistent malfunctioning peritoneal catheters. The aim of the study is to analyse the cost-effectiveness of videolaparoscopic interventions based on a simulation of reimbursement costs.
Reimbursement costs of catheter malfunction management are calculated for the following two simulations: Hospitalisation for videolaparoscopic revision and follow up in daily automated home PD versus termination of PD, placement of a temporary central venous catheter, creation of an arterio-venous fistula and in-centre bicarbonate haemodialysis (HD) with highly biocompatible membranes three times a week. 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 (videolaparoscopic intervention 8597 Euro + PD 383 Euro/week versus vascular access 4551 Euro + HD 496 Euro/week) was determined at 36 weeks after intervention.
43 videolaparoscopic revisions were performed during the observation period. 12 patients were still on PD at the end of the observation period (prolungation 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 after intervention was 4068 weeks, in confront to 1548 weeks needed to reach break-even. Theoretical savings amount to 284.760 Euro during the period of ten years. This is equivalent to annual dialysis costs of 14 patients in APD, respectively 16 patients in CAPD.
The need of videolaparoscopic revision at catheter malfunction annuls the economic advantage of PD. A cost-effective videolaparoscopic 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 the cost-effectiveness of the procedure.
