Nephrol Dial Transplant (2003) 18: 390-396
© 2003 European Renal Association-European Dialysis and Transplant Association
Economic impact of extended time on peritoneal dialysis as a result of using polyglucose: the application of a Markov chain model to forecast changes in the development of the ESRD programme over time
1 Centre for Health Policy and Law, Erasmus University Rotterdam, Rotterdam, The Netherlands, 2 Department of Nephrology, University Hospital St Radboud, Nijmegen, The Netherlands, 3 Renal Division, Baxter Healthcare Inc., Deerfield, IL, USA, 4 Renal Unit, AMC, University of Amsterdam, Amsterdam, The Netherlands, 5 Department of Nephrology, Red Cross Hospital, The Hague, The Netherlands and 6 Department of Nephrology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Background. The use of polyglucose as a peritoneal dialysis (PD) fluid extends time on PD treatment. It is anticipated, therefore, that the share of patients treated with PD will be positively influenced. The relationship between extension of PD treatment time and an increase of the PD treatment share, however, is complex and needs further investigation. In this paper, a Markov chain model was applied to investigate the impact of extended time on PD treatment for the PD share in all dialysis patients in The Netherlands. Furthermore, the economic impact of the extended time on treatment (ETOT) was explored.
Methods. Scenarios were forecast over a 10 year period using aggregate data from the End-Stage Renal Registry in The Netherlands (Renine). Three scenarios were simulated in which the median PD technique survival was extended by 8, 10 and 12 months. Two other scenarios explored the impact of the combined effect of ETOT of 10 months together with a 10% and 20% increase of PD inflow shares. Reductions of costs to society due to ETOT were estimated using Dutch cost data on renal replacement therapies.
Results. PD share increases from 30.0% in the null scenario to 34.5% in the scenario with an ETOT of 10 months and an increased PD inflow share of 20%. The reduction in total costs to society of the renal replacement therapies is 0.96%. The average societal costs per discounted patient year for haemodialysis (HD) are €84 100. For PD, these costs are €60 300. A shift from HD to PD results in average cost savings of 28% per patient year.
Conclusions. In view of high dialysis costs to society, a reduction of 0.96% can be considered to be relevant for healthcare policy makers.
Keywords: economic evaluation; extended time on treatment; Markov chain modelling; peritoneal dialysis; polyglucose
Correspondence and offprint requests to: T. J. G. Weijnen, MSc, PO Box 1738, NL-3000 DR Rotterdam, The Netherlands. Email: weijnen{at}frg.eur.nl
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