Economic evaluation of urgent-start peritoneal dialysis versus urgent-start hemodialysis in the United States

Frank Xiaoqing Liu, Arshia Ghaffari, Harman Dhatt, Vijay Kumar, Cristina Balsera, Eric Wallace, Quresh Khairullah, Beth Lesher, Xin Gao, Heather Henderson, Paula LaFleur, Edna M Delgado, Melissa M Alvarez, Janett Hartley, Marilyn McClernon, Surrey Walton, Steven Guest, Frank Xiaoqing Liu, Arshia Ghaffari, Harman Dhatt, Vijay Kumar, Cristina Balsera, Eric Wallace, Quresh Khairullah, Beth Lesher, Xin Gao, Heather Henderson, Paula LaFleur, Edna M Delgado, Melissa M Alvarez, Janett Hartley, Marilyn McClernon, Surrey Walton, Steven Guest

Abstract

Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization. However, there has been no assessment of the dialysis-related costs over the first 90 days of care. The objective of this study was to characterize the costs associated with urgent-start PD, urgent-start hemodialysis (HD), or a dual approach (urgent-start HD followed by urgent-start PD) over the first 90 days of treatment from a provider perspective. A survey of practitioners from 5 clinics known to use urgent-start PD was conducted to provide inputs for a cost model representing typical patients. Model inputs were obtained from the survey, literature review, and available cost data. Sensitivity analyses were also conducted. The estimated per patient cost over the first 90 days for urgent-start PD was $16,398. Dialysis access represented 15% of total costs, dialysis services 48%, and initial hospitalization 37%. For urgent-start HD, total per patient costs were $19,352, and dialysis access accounted for 27%, dialysis services 42%, and initial hospitalization 31%. The estimated cost for dual patients was $19,400. Urgent-start PD may offer a cost saving approach for the initiation of dialysis in eligible patients requiring an urgent-start to dialysis.

Figures

FIGURE 1
FIGURE 1
Urgent-Start Dialysis Clinical Pathway, Days 0 to 90. ∗Dual is defined as having urgent HD for 2 sessions followed by Initiation of PD.

References

    1. Swaminathan S, Mor V, Mehrotra R, Trivedi A. Medicare's payment strategy for end-stage renal disease now embraces bundled payment and pay-for-performance to cut costs. Health Aff (Millwood) 2012; 31:2051–2058.
    1. U.S. Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: USRDS; 2013.
    1. Golper TA, Guest S, Glickman JD, et al. Home dialysis in the new USA bundled payment plan: implications and impact. Perit Dial Int 2011; 31:12–16.
    1. Hornberger J, Hirth RA. Financial implications of choice of dialysis type of the revised Medicare payment system: an economic analysis. Am J Kidney Dis 2012; 60:280–287.
    1. Hirth RA, Turenne MN, Wheeler JR, et al. The initial impact of Medicare's new prospective payment system for kidney dialysis. Am J Kidney Dis 2013; 62:662–669.
    1. Liu Y, Zhang L, Lin A, et al. Impact of break-in period on the short-term outcomes of patients started on peritoneal dialysis. Perit Dial Int 2014; 34:49–56.
    1. Oliver MJ, Verrelli M, Zacharias JM, et al. Choosing peritoneal dialysis reduces the risk of invasive access interventions. Nephrol Dial Transplant 2012; 27:810–816.
    1. Perl J, Wald R, McFarlane P, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 2011; 22:1113–1121.
    1. Ravani P, Gillespie BW, Quinn RR, et al. Temporal risk profile for infectious and noninfectious complications of hemodialysis access. J Am Soc Nephrol 2013; 24:1668–1677.
    1. Kosa SD, Lok CE. The economics of hemodialysis catheter-related infection prophylaxis. Semin Dial 2013; 26:482–493.
    1. Engemann JJ, Friedman JY, Reed SD, et al. Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis. Infect Control Hosp Epidemiol 2005; 26:534–539.
    1. Ghaffari A. Urgent-start peritoneal dialysis: a quality improvement report. Am J Kidney Dis 2012; 59:400–408.
    1. Casaretto A, Rosario R, Kotzker WR, et al. Urgent-start peritoneal dialysis: report from a U.S. private nephrology practice. Adv Perit Dial 2012; 28:102–105.
    1. Mahnensmith RL. Urgent-start peritoneal dialysis: what are the problems and their solutions? Semin Dial 2014; 27:291–294.
    1. Lobbedez T, Lecouf A, Ficheux M, et al. Is rapid initiation of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience. Nephrol Dial Transplant 2008; 23:3290–3294.
    1. Chambers JD, Weiner DE, Bliss SK, Neumann PJ. What can we learn from the U.S. expanded end-stage renal disease bundle? Health Policy 2013; 110:164–171.
    1. Ghaffari A, Kumar V, Guest S. Infrastructure requirements for an urgent-start peritoneal dialysis program. Perit Dial Int 2013; 33:611–617.
    1. Bureau of Labor Statistics. Medical Care Consumer Price Index All Urban Consumers. US Department of Labor: Available at: Accessed on June 4, 2014.
    1. American Hospital Association. Fast Facts on US Hospitals. Available at: Accessed on June 4, 2014.
    1. Henry J Kaiser Family Foundation. Hospital Adjusted Expenses per Inpatient Day by Ownership. Available at: Accessed on June 4 2014.
    1. Centers for Medicare Medicaid Services. CY 2013 OPPS Comparison Between Proposed Geometric Mean and Median Based Payments. Available at: Accessed on June 4 2014.
    1. Gomes A, Schmidt R, Wish J. Re-envisioning Fistula First in a patient-centered culture. Clin J Am Soc Nephrol 2013; 8:1791–1797.
    1. Department of Labor Bureau of Labor U.S. Statistics. Occupational Employment Statistics. Available at: Accessed on June 4, 2014.
    1. Bureau of Labor Statistics. Economic News Release. Available at: Accessed on June 4, 2014.
    1. Fresenius Medical Care. Fresenius Medical Care Ancillary Products Listed by Product Type. Available at: Accessed on June 4, 2014.
    1. Ingenix OptumCoding. National Fee Analyzer. Optuminsight 2013.
    1. Centers for Medicare Medicaid Services. 2013 ASP Drug Pricing Files, July 2013. Available at: Accessed on June 4, 2014.
    1. Aslam N, Bernardini J, Fried L, et al. Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients. Clin J Am Soc Nephrol 2006; 1:1226–1233.
    1. HCUPnet. Healthcare Cost and Utilization Project (HCUP). 2011; Rockville, MD: Agency for Healthcare Research and Quality, Available at: /. Accessed on June 4, 2014.
    1. Xue H, Ix JH, Wang W, et al. Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications. Am J Kidney Dis 2013; 61:123–130.
    1. Arramreddy R, Zheng S, Saxena AB, et al. Urgent-start peritoneal dialysis: a chance for a new beginning. Am J Kidney Dis 2014; 63:390–395.
    1. Koch M, Kohnle M, Trapp R, et al. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 2012; 27:375–380.
    1. Just PM, Riella MC, Tschosik EA, et al. Economic evaluations of dialysis treatment modalities. Health Policy 2008; 86:163–180.
    1. Liu FX, Quock TP, Burkart J, et al. Economic evaluations of peritoneal dialysis and hemodialysis: 2004–2012. F1000Research 2013, 2:273 (doi:10.12688/f1000research.2-273.v1). Available at: Accessed on June 4, 2014.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir