Análisis costo-efectividad de retornar a diálisis peritoneal los pacientes con hemodiálisis previa

Introduction

Dialysis presents a financial challenge for health institutions. The overall objective of this study was to identify the cost of investment in re-admissions to peritoneal dialysis (PD) after prior hemodialysis (HD).

Material and methods

Cross-sectional, open study conducted from January to October 2013. Demographic variables included: initial and subsequent dialysis, cause of admission to HD, time on HD, cost of the return to PD process (lab tests, meetings, inter-departmental consultations, surgical time, intermittent PD, bed days, and total cost); substitution and internal HD sessions that could be added to the estimated economic investment.

Results

A total of 10 patients, 6 male and 4 female, mean age 49.4 years (range: 26-75), all with type 2 diabetes mellitus, were included. The tests performed included; 6 abdominal ultrasounds, 11 X-rays (mean: 1.1; range: 0-2), 11 electrocardiograms (mean: 1.1; range: 0-2), and 135 laboratory tests, with a mean of 13.5 per patient (range: 7-26). One abdominal CT scan was performed. Peritoneal catheters were inserted surgically. There were 89 sessions of Intermittent peritoneal dialysis (mean: 8.9; range: 0-14) using 210 bed days (mean: 21; range: 13-27). The resolution of the cases was one entry to substitution HD program, 1 death, 1 dropout, 2 continuous ambulatory, 4 automated, and 1 intermittent peritoneal dialysis. The total cost of comprehensive care was 1,381,810.79 Mexican pesos, average per patient of 138,181.07 (range: 101,094.38 to 197,710.38).

Conclusions

The return of hemodialysis substitution patients to peritoneal dialysis did not prove to be cost effective for the hospital.