EXECUTIVE ORDER ON ADVANCING AMERICAN KIDNEY HEALTH: A MARKOV ANALYSIS OF LONG-TERM COSTS

Abstract

Background: Hemodialysis (HD) remains the most common method for renal replacement therapy (RRT) in the United States. On July, 2019 an Executive Order released from the Trump administration recommended swift action to increase the rate of home dialysis/peritoneal dialysis (PD) utilization (1). It remains unclear to what extent such a measure would affect long-term costs for end-stage renal disease (ESRD) patients. Methods: A decision analytic Markov state transition model was created to simulate the life of ESRD patients as they transitioned through life (transplant, death, graft failure). Two patient groups were created whereby patients underwent either initial RRT with 1) PD or 2) HD. State transitions to end-stage renal disease requiring dialysis, transplantation, and death were modeled, as well as associated costs. Sensitivity analysis of the ratio of patient undergoing initial PD vs. HD was estimated. Base case patients were defined as being a 55 years old patient. Markov parameters were extracted from literature review (2-5). Results: Increased utilization of home dialysis therapy/PD was associated with reduced total lifetime costs. Compared to current-era PD utilization, 80% PD catheter use, as recommended by recent Executive Order was associated with a $39,029 reduction in costs per patient ($530,984 vs. $491,954). For the current kidney transplant waitlist population, an estimated $3.6 billion savings is estimated with successful implementation of Executive Order. Conclusion: Implementation of recent Executive Order on Advancing American Kidney Health is estimated to drastically reduce total healthcare spending for ESRD patients.