PUK5 - A Pilot Study on Cost Evaluation of Urgent Start Automated Peritoneal Dialysis and Hemodialysis in the Treatment of End-Stage Renal Disease in São Paulo, Brazil

Abstract

Compare the outcomes and the direct medical costs of urgent start hemodialysis (HD) and automated peritoneal dialysis (APD) by six months in a Brazilian center. In this prospective study, we describe dialysis related events, resources used and amounts reimbursement for them by the Brazilian public health care system in a cohort of patients on urgent start HD and APD. We assessed 20 patients on each method in the first six months of therapy. We considered direct medical costs the amounts reimbursed for hospitalization, laboratory exams, chronic kidney disease (CKD) specific medications, maintenance dialysis, clinical complications related to dialysis, dialysis access and its complications. There was no difference between the APD group and HD group in age (55.3±15.2 vs 57.6±15.0, p=0.65), male sex (70 vs 60%, p=0.74), transplantation (0 in both groups) and mortality (0 vs 10%, p=0.48). There was difference in etiology of CKD (diabetes: 45 in APD vs 10% in HD group, p=0.03). The total direct cost per patient–semester was similar: US$6091.7±1289.4 for urgent start APD and US$ 6209.1±1600 for HD (p=0.45). By category, the main direct costs consisted of maintenance dialysis (75.2 for HD vs. 80.3% for APD, p=0.04), hospitalization (0 for HD vs 2.1% for APD, p<0.001), laboratory exams (1.6 for HD vs 1.7% for APD, p=0.29), dialysis access and its mechanical complications (9.3% for HD vs. 3.7% for APD, p<0.001), infectious treatment (2.54 vs 1.1%, p=0.94) and medications (12.3 for HD vs. 9.6% for APD, p=0.15). Overall costs were similar in urgent start APD and HD and maintenance dialysis represented the most important source of costs for both modalities, being higher for APD. Unplanned HD had higher dialysis access costs than PD, while PD had higher costs with hospitalizations than HD. These are interesting characteristics of unplanned dialysis modalities.