# Center Hemodialysis Versus Peritoneal Dialysis: A Cost-Utility Analysis

## TL;DR

This study compares the cost-effectiveness of peritoneal dialysis and hemodialysis for kidney disease patients in Germany.

## Contribution

The paper provides a novel cost-utility analysis comparing PD and HD in the German healthcare context.

## Key findings

- Peritoneal dialysis (PD) is more cost-effective and improves quality of life compared to hemodialysis (HD).
- PD shows greater cost per QALY in physical dimensions compared to mental dimensions.
- Significant variability exists among patients, emphasizing the need for individualized treatment decisions.

## Abstract

Introduction

Kidney replacement therapy (KRT) is needed for patients with end-stage kidney disease. While it is clear that kidney transplantation remains the gold standard in KRT, data comparing the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) are scarce. No such analysis has been performed for German patients.

Methods

We used aggregated data generated by the Short Form 36 Health Survey (SF-36) for quality of life and insurance claims to evaluate mortality and economic impact. Quality-adjusted life years (QALY) and cost-utility were calculated accordingly.

Results

PD is superior to HD within all dimensions of the SF-36, both in terms of QALY and cost-utility. The difference in cost per QALY between the aggregated physical dimensions (€50,671.54 vs. €39,745.77) is greater than that of the aggregated mental dimensions (€31,638.75 vs. €25,287.63). However, there is considerable variability among patients.

Conclusion

From a health-economic point of view, PD should be preferred over HD when deciding on the KRT modality for the patient. This is not reflected in current practice, though. However, interindividual differences and patient preferences should be considered in the decision.