Cost Savings Associated with Extending Patient Time on Peritoneal Dialysis

Background: Only 7.1% of end-stage kidney disease (ESKD) patients receive peritoneal dialysis (PD) (USRDS, 2019). This number is expected to increase dramatically because of a 2019 U.S. presidential executive order which set the goal for 80% of patients to receive treatment at home or a transplant by 2025. To achieve this goal, providers and payers will not only need to encourage the use of PD but also will need to mitigate PD technique failure (TF). McGill et al. (AJKD, 2019) found that 6 out of 7 patients who start treatment with PD experience TF and will switch to hemodialysis (HD) within five years. Of patients who switch, Jaar et al. (BMC Nephrology, 2009) found that 20% did so by 6 months. Improving PD treatment time is important for patient quality of life and reducing healthcare costs. The goal of this study was to model Medicare cost savings associated with extending patient time on PD. Methods: Using USRDS data, we calculated total Medicare spending per patient per day to be $226.71 for PD and $266.26 for HD, respectively. We estimated potential savings if treatment with PD could be extended each month up to 1 year using a base case of an incident ESKD patient who transitions to HD after receiving PD for 6 months. We assumed that during this year patients neither had a transplant nor died and that patients received HD once they stopped PD. Results: Extending PD beyond 6 months for incident patients could result in potential savings to payers. Extending PD by 1 month, 2 months, 3 months, 4 months, 5 months, or 6 months could save $1,203.05, $2,406.10, $3,609.15, $4,812.20, $6,015.25, or $7,218.30, respectively per patient. We found that if a patient could avoid TF, $14,436.59 could be saved annually. Conclusions: Extending the PD treatment time beyond 6 months has the potential to reduce treatment costs by $1,203.05-$7,218.30 for patients staying on PD 1 month to 6 months longer, respectively. Annually, avoiding TF could result in savings of $14,436.59. Multiple risk factors are associated with TF. Focusing on identifying and addressing modifiable conditions may help to keep more patients dialyzing at home. Funding: Commercial Support - Fresenius Medical Care North America Renal Therapies Group

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