Cost-effectiveness of acute peritoneal dialysis: Considerations from Africa.

Abstract

Acute kidney injury (AKI) is currently an important public health problem with high morbidity and mortality especially in low- and middle-income countries. In these low-resource settings, prevention of death from severe AKI involves well-coordinated intensive care services, which are often absent or expensive. Provision of cost-effective interventions that are widely available and accessible to everyone is important. Acute peritoneal dialysis (PD), which is technically more economical than hemodialysis, could potentially become a cost-effective solution in the management of severe AKI. An acute PD project in Moshi, Tanzania, was used to assess the cost-effectiveness of PD using a comparison between subsidized and privately procured resources. The average cost per AKI course of treatment with PD when subsidized was USD 420, while if the same treatment was privately procured it was USD 788. Using a WHO guideline that categorizes interventions costing less than once the national annual GDP per capital as highly cost-effective, the Moshi PD project was found to be an appropriate example because the intervention cost (USD 788) was lower than the GDP per capita of Tanzania (USD 879 in 2012). If more countries develop similar programs in sub-Saharan Africa, particularly for children, this would allow for increased opportunity for economies of scale in the supply of consumables and could lower costs over the long term. Ministries of health in low-resource settings should consider developing programs for provision of acute PD to achieve equitable, cost-effective, and sustainable programs for treatment of AKI and subsidies to increase access to lower-income patients.