A return to PD?

The United States could save more than $1 billion in five years if just 15 percent of all dialysis patients used peritoneal dialysis (PD), according to a study published in Clinical Therapeutics (2009; 31:880–888). PD is an alternative to hemodialysis that uses the peritoneal membrane around the stomach to filter the patient’s blood with the help of dialysate that is infused and drained by catheter.

The study was supported by a grant from Baxter Healthcare, which makes a PD system called Homechoice Pro. The researchers performed a five-year budget-impact analysis using data from the 2007 U.S. Renal Data System report.

The study concluded that PD has better survival rates than in-center hemodialysis. PD is also less expensive than hemodialysis by thousands per year per patient. The authors found that if PD use decreased to 5 percent of dialyzing patients over the next five years, Medicare spending on end stage renal disease patients would jump by about $401 million.

However, if the percentage of PD patients increased to 13 percent over the next five years, then Medicare would save nearly $826 million. And if its use increased to 15 percent by the end of five years, Medicare could see savings of more than $1.1 billion, according to the study. Savings would come from fewer hospitalizations and lower drug spending levels for the overall younger patients who undergo PD, the authors noted.

One blogger in the dialysis world took issue with the study findings about the actual cost savings: “Providing PD to people in SNF (skilled nursing facilities) is highly problematic, so you have to assume that growing the percent of people who use PD would create savings from switching people who are not in an SNF and who would have otherwise used HD. This would suggest $11,400 in savings rather than the $18,900 the authors use to get their savings of one billion dollars over five years. More on dialysis observer Bill Peckham’s arguments can be found at http://www.billpeckham.com/from_the_sharp_end_of_the/2009/05/fail-clinical-therapeutics-paper-gets-the-math-wrong-and-misses-the-point.html.