Incremental compared with full-dose peritoneal dialysis: a cost analysis from a third-party payer perspective in Australia

Introduction: Incremental peritoneal dialysis (PD) prescriptions, tailored to individual patient needs and residual kidney function, may offer patients greater dialysis-free time than full-dose PD and has the potential to yield substantial cost savings. We aimed to quantify the direct healthcare costs and resource utilization associated with incremental and full-dose PD from a third-party health service payer's perspective and estimate dialysis-free time and dialysis waste saved. Methods: We recruited patients from a large dialysis service provider in Australia. We retrospectively analysed prospectively collected hospital data from 203 incident patients receiving PD over a 24-month period. Incremental PD was compared to full dose, considering costs related to consumables, multidisciplinary reviews, pathology, and in-patient costs. Results: Of the 204 incident patients recruited in the study, 123 (60%) were prescribed incremental PD, with mean age of 62 years, and 66% being male. The total mean monthly outpatient cost ($AUD) for any dose of incremental PD was $339 (95% CI $152, -$526, p< .001) less than full dose, with PD consumables as the greatest contributor to the cost difference. At the end of the study, the mean dwell and exchange procedure times were 5065 h (4222–5908) and 455 h (403–507) lower in incremental PD than full dose, respectively, and incremental PD prescriptions saved >2 million litres of water, >9000 kg plastic and >8000 kg cardboard. Conclusion: Compared to full dose, incremental PD minimizes dialysis time and is associated with lower costs and dialysis waste, driven largely by reduction in consumables use.