INTRODUCTION AND AIMS: Approximately 54,000 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-centre haemodialysis (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 70%, 80%, and 95% respectively. 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 €142 million, and €293 million, respectively. If the prevalent PD population were to decrease from 9% to 5%, the total expenditure for dialysis treatments would increase by €84 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
