Hemodialysis and peritoneal dialysis cost and cost-effectiveness analysis: University hospital example

Background and Aim: Chronic kidney disease is a significant burden on healthcare systems due to its increasing prevalence and high treatment costs. Hemodialysis (HD) and peritoneal dialysis (PD) are the most commonly used modalities for the treatment of end-stage renal failure. The aim of this study was to compare the total costs, the incremental cost-effectiveness ratios and quality of life effects of HD and PD treatment modalities in a university hospital. Material and Methods: The study was conducted retrospectively and cross-sectionally on patients receiving HD and PD treatment at Trakya University Hospital in 2023. Cost data included treatment, medication, medical consumables, personnel and overhead items, and total annual costs per patient were calculated in detail. EQ-5D-5L and KDQOL-36 scales were used for clinical and quality of life assessments. The incremental cost-effectiveness ratio was calculated on both quality of life and cost data for both groups; statistical analyses were performed with Mann-Whitney U test and regression. Results: The total cost of HD treatment per patient per year was determined as 214,898 TL with the traditional method, while this value was determined as 218,789 TL for PD. However, while the cost of HD within the scope of the Health Implementation Communiqué is 140,311 TL, the SUT cost of PD is 218,789 TL. In cost analyses, overhead and personnel costs of HD were found to be higher compared to PD. In quality of life assessments, higher scores were obtained in some sections of the EQ-5D-5L index scores and KDQOL-36 subscales in the PD group compared to HD. According to the results of ICER analysis, PD stands out as a more cost-effective option than HD in certain patient profiles. However, HD provides some clinical advantages in patients with advanced age and comorbidities. Conclusion: The study revealed the cost and cost-effectiveness differences between HD and PD treatment modalities in terms of healthcare services and provided important data for shaping healthcare policies accordingly. Promoting PD in certain patient groups may increase economic sustainability. The findings suggest that more balanced treatment strategies should be developed, taking into account patient quality of life and economic aspects. Keywords: Hemodialysis, peritoneal dialysis, cost analysis, ICER, quality of life