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The prevalence of morbidity and mortality related to chronic kidney disease (CKD) is extensive. At stage 5, renal support therapy is necessary; however, several patients are admitted with residual renal function. This function is quantified by a urea clearance of 3 ml/min or greater. By supplementing the dialysis clearance dose with this renal function dose, intervention with a lower dialysis dose may be attained.
Since chronic kidney disease (CKD) on dialysis presents a significant burden on the Colombian social health system, utilizing an incremental approach may prove to be a cost-effective strategy in comparison to full-dose dialysis. Previous assumptions suggested that less frequent hemodialysis (HD) would result in higher costs and workload compared to incremental peritoneal dialysis (PD), however, no comparative cost-effectiveness study has been performed. The present study aims to evaluate the cost-effectiveness of utilizing incremental PD in comparison to conventional HD for the management of CKD in Colombia.
Determine the cost-effectiveness ratio between less frequent HD and incremental PD in Colombia. We developed a Markov model that estimates the costs and QALYs related to health for less frequent HD compared to incremental PD, from both the Colombian health system perspective (direct medical costs) and societal perspective over 2, 3-, and 5-year periods. We subjected data on effectiveness, costs, and discount rates to sensitivity analysis. The conversion of Colombian Pesos (COP) to United States Dollars (USD) was executed using the average exchange rate for 2022 (1 USD = 4255.44), as per the official report of the Republic Bank of Colombia.
When analyzing the results probabilistically, it was found that incremental PD incurred a total cost (direct and out-of-pocket) of COP 60,146,842.45 (USD 14,134.1) and led to 1.3545 QALYs after 24 months, whereas infrequent HD incurred a cost of COP 60,835,853.44 (USD 14,296.01) and led to 1.2953 QALYs.
At 48 months, there is a significant cost difference, with incremental peritoneal dialysis (PD) costing USD$26,111.174 and providing 2.3090 quality-adjusted life years (QALYs), while less frequent hemodialysis (HD) costs USD$27,835.31 and provides 1.2953 QALYs.
At 60 months, the difference continues to widen, with incremental PD costing USD$31,142.7 and providing 2.6922 QALYs, while less frequent HD costs USD$33,606.38 and provides 2.5291 QALYs.
: If residual kidney function is maintained, the costs and impact on quality of life may be comparable for the incremental approach dialysis modalities over an average of 2 to 3 years. However, over a longer time horizon, such as the simulated 5 years, lower-dose peritoneal dialysis still offers better cost-effectiveness and quality of life. Thus, for a 24-month time horizon, less frequent hemodialysis can be considered an equally cost-effective strategy to incremental peritoneal dialysis.