Peritoneal dialysis (PD) is more cost-effective than hemodialysis (HD) for patients with chronic kidney diseases, a local study showed. It was the first time in Korea that a study compared the cost-effectiveness of HD and PD.
Researchers at several domestic hospitals disclosed the results of the study, titled “Prospective cohort of Korean end-stage kidney disease (ESKD) patients for cost-effectiveness analysis of hemodialysis and peritoneal dialysis,” at a public hearing for policymaking to help patients choose a reasonable dialysis method. The public hearing took place at the Seoul National University Hospital’s Biomedical Research Institute on Friday.
The cohort study, which began in 2016 at Kyungpook National University Hospital, SNUH, and Konkuk University Hospital, analyzed life years gain (LYG) and quality-adjusted life years (QALY) of patients who started HD or PD at the age of 50, using the Markov analysis model.
The Markov model helps analyze a chain of situations statistically and find an optimal value. The latest study set the analysis period of 50 years, assuming that patients die at the age of 100, and estimated their medical costs every year.
Lee Kun-sei, a professor at Konkuk University's College of Medicine, said PD had better outcomes than HD concerning cost-effectiveness, during his presentation on the “cost-effectiveness of HD and PD in a prospective cohort of Korean ESRD patients.”
According to Lee, HD and PD had no significant difference in therapeutic effects. However, HD was slightly more beneficial for LYG improvement, and PD, better for QALY. Regarding cost, PD was more advantageous because HD needed 37 million won ($32,860) per patient, while PD required 25 million won, on average.
PD was found to have been more economically advantageous than HD, even when considering both possibilities of a change in the dialysis method and no change in the dialysis method.
“While more than 90 percent of all Korean patients undergo HD, our study showed that PD was cost-effective although HD and PD had no significant differences in dialysis outcomes. It must have been better if this study had taken place earlier,” Lee said.
According to the Korean Society of Nephrology, 73,059 patients received HD while 6,475 had PD in 2017. In other words, only 8.14 percent of the dialysis patients underwent PD last year.
“Korea needs a system to help patients choose a reasonable dialysis method. The government should raise medical payments to doctors using PD and provide a systematic education for patients to encourage them to make a reasonable choice,” Lee said.
Lee suggested that primary and secondary medical institutions exchange patients with tertiary hospitals. “The government should establish a special medical payment system for PD and change once-in-a-lifetime counseling payment to a regular payment,” he added.
Lee went on to say that the government should build an infrastructure to enable “self-care” for kidney patients.
“It is important to educate patients to delay the time of dialysis. We should make sure that they don’t get emergency dialysis through regular education programs,” Lee said. “The government should include renal diseases to the early diagnosis management system.”