Éléments de problématique économique dans le domaine de l'épuration extra-rénale

Abstract

The aim of this paper is to enlighten, in an economic perspective, the ongoing debate which has emerged surrounding the question of the respective place of peritoneal dialysis and haemodialysis in the treatment of terminal renal failure. In order to accomplish this, the authors used a cost effectiveness approach aiming to create a link between two kinds of data: data on the effectiveness of treatment methods on the one hand, and data on the costs associated with such treatment modalities on the other. The international literature tends to show that the two dialysis techniques are comparable in terms of effectiveness, except in the case of diabetic patients, for a significantly lower treatment cost in the case of peritoneal dialysis as opposed to haemodialysis, regardless of the geographical location and in spite of certain methodological biases existing due to the sample sizes implemented in the cost studies. All things considered, it seems that in comparison to haemodialysis methods, peritoneal dialysis results in lower cost effectiveness ratios (that is to say, lower cost of treatment to attain a certain level of effectiveness). The conclusion of this report therefore emphasizes the need to develop and promote peritoneal dialysis, in situations where this modality is clinically applicable, in countries where it is currently underused, which is the case in France.