COST-EFFECTIVENESS OF PERITONEAL DIALYSIS VERSUS HEMODIALYSIS FOR END-STAGE RENAL DISEASE IN TURKEY
Author(s)
AYSEN SENTURK, MSc1, Engin SENTURK, BSc1, Volkan Dogan, MSc2, Fuat Çukadar, MSc2;
1Axel Health Solutions, Ankara, Turkey, 2Vantive Health, Istanbul, Turkey
1Axel Health Solutions, Ankara, Turkey, 2Vantive Health, Istanbul, Turkey
OBJECTIVES: Renal replacement therapy modalities differ in clinical outcomes, patient burden, and economic impact. This study evaluated the cost-effectiveness of peritoneal dialysis (PD) versus hemodialysis (HD) for adults with end-stage renal disease (ESRD) in Turkey using a country-adapted economic model.
METHODS: A cohort Markov model with 28-day cycles was adapted from a global framework to reflect Turkish epidemiology, practice patterns, and unit costs. The model followed a prevalent ESRD dialysis population over 10 years from the payer perspective, with an additional analysis including selected indirect costs. Health states included remaining on the initial modality, switching between modalities, transplantation, post-transplant, and death. Transition probabilities were sourced from published evidence, including ERA-EDTA survival curves parametrized with Gompertz functions and national registry data inputs. Utility values for PD, HD, and post-transplant states were obtained from a systematic review. Direct cost inputs were derived from Turkish reimbursement tariffs, local economic literature, and expert-based resource-use estimates. Direct costs included access procedures, dialysis sessions, pharmacotherapy, complications, hospitalizations, transplantation, and post-transplant follow-up; indirect costs captured transportation and household utility expenses. Costs and outcomes were discounted at 3% annually. Outcomes assessed were total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
RESULTS: PD dominated HD, providing greater health gains at lower total cost. Over 10 years, PD generated an estimated cost saving of 1.178.880 TRY per patient, equivalent to 27,401 USD (Fx Rate: 43.0227 TRY). PD produced an additional 0.209 LYs and 0.184 QALYs compared with HD, demonstrating superiority in both effectiveness and cost outcomes.
CONCLUSIONS: In Turkey, PD is both less costly and more effective than HD over a 10-year horizon. These results support PD as a clinically advantageous and economically favorable modality for ESRD management and highlight its relevance in national renal replacement therapy planning.
METHODS: A cohort Markov model with 28-day cycles was adapted from a global framework to reflect Turkish epidemiology, practice patterns, and unit costs. The model followed a prevalent ESRD dialysis population over 10 years from the payer perspective, with an additional analysis including selected indirect costs. Health states included remaining on the initial modality, switching between modalities, transplantation, post-transplant, and death. Transition probabilities were sourced from published evidence, including ERA-EDTA survival curves parametrized with Gompertz functions and national registry data inputs. Utility values for PD, HD, and post-transplant states were obtained from a systematic review. Direct cost inputs were derived from Turkish reimbursement tariffs, local economic literature, and expert-based resource-use estimates. Direct costs included access procedures, dialysis sessions, pharmacotherapy, complications, hospitalizations, transplantation, and post-transplant follow-up; indirect costs captured transportation and household utility expenses. Costs and outcomes were discounted at 3% annually. Outcomes assessed were total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
RESULTS: PD dominated HD, providing greater health gains at lower total cost. Over 10 years, PD generated an estimated cost saving of 1.178.880 TRY per patient, equivalent to 27,401 USD (Fx Rate: 43.0227 TRY). PD produced an additional 0.209 LYs and 0.184 QALYs compared with HD, demonstrating superiority in both effectiveness and cost outcomes.
CONCLUSIONS: In Turkey, PD is both less costly and more effective than HD over a 10-year horizon. These results support PD as a clinically advantageous and economically favorable modality for ESRD management and highlight its relevance in national renal replacement therapy planning.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE404
Topic
Economic Evaluation
Disease
SDC: Urinary/Kidney Disorders