Presentation (CTI)

OBJECTIVES: End-stage kidney disease (ESKD) imposes significant economic burdens on healthcare systems globally due to increasing patient populations and high treatment costs. This study assessed demographic trends, healthcare expenditures, and budget impacts of actively increasing peritoneal dialysis (PD) utilization compared to maintaining current dialysis modalities among ESKD patients in South Korea.
METHODS: A retrospective cohort analysis was conducted using data from the Korean National Health Insurance Service (2018-2022). The analysis included adult patients who received dialysis for three months or longer, excluding those with concurrent PD and hemodialysis (HD), early dialysis discontinuation, or kidney transplantation. Propensity score matching was used to compare dialysis method distribution and annual medical costs per patient. A budget impact model projected financial outcomes under scenarios of current dialysis trends versus policies actively promoting PD.
RESULTS: From 2018 to 2022, HD patient numbers increased by 23.0% (annual growth rate 6.8%), while PD patient numbers decreased by 8.5% (annual decline rate 1.6%). The per-patient medical cost was approximately 1.4 times higher for HD than for PD. Without intervention, PD utilization is projected to decline to approximately 2% by 2033, substantially threatening healthcare sustainability. Currently, total annual dialysis-related medical costs are approximately USD 4.74 billion, with significant increases expected if trends persist. Implementing policies to increase PD prevalence to 17% by 2033, including financial incentives and hospital subsidies, could reduce annual healthcare expenditures to USD 4.52 billion. Potential annual savings of approximately USD 200 million, avoided productivity losses of USD 203 million, and additional health insurance revenues of USD 43 million are projected under this scenario.
CONCLUSIONS: Increasing PD utilization significantly reduces healthcare spending and productivity losses, yielding substantial socioeconomic benefits. Urgent policy intervention addressing non-economic barriers to PD adoption is needed to maintain PD sustainability and optimize dialysis strategies, benefiting patients and the broader healthcare system.