PAYMENT DESIGN AS A BARRIER TO PERITONEAL DIALYSIS IN MOROCCO: A PROVIDER-MARGIN FRONTIER AND PD-FIRST BUDGET-IMPACT ANALYSIS
Author(s)
Omar Maoujoud, MD, PhD1, Amal Yassine, MD, PhD1, Intissar Haddiya, MD, PhD2.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
OBJECTIVES: Peritoneal dialysis (PD) is clinically equivalent to haemodialysis (HD) yet remains marginal in Morocco, used by fewer than 200 patients against more than 45,000 on HD. Its flat weekly forfait was set equal to the HD reimbursement ceiling. We tested whether this pricing, not clinical performance or cost, constrains PD uptake, tracing its effect on payer savings and provider incentives.
METHODS: We developed two linked models from the payer (AMO) perspective in MAD, reimbursement and real-cost bases kept separate. The first, a steady-state provider-margin model, expressed annual margin as the annualised forfait minus consumable cost at n daily exchanges, the 2L bag at the regulated hospital price. The second, a five-year PD-First budget-impact model (3% discount), reallocated 10% of incident dialysis patients to PD with technique failure (67% HD transfer, 18.5-month median survival), comparing the parity tariff with a cost-recovery bundle. Dual engines, Excel-Python reconciliation, one-way sensitivity, and 10,000-iteration probabilistic analysis validated outputs.
RESULTS: At parity, PD-First produced no five-year payer saving: the forfait equals the HD ceiling, so PD's lower cost never reaches the AMO. Provider economics were as adverse: before non-consumable costs, margin was +2,840 MAD/month at the standard CAPD dose (four exchanges/day), near zero at the automated PD mean (five cycles/night), and negative beyond, the forfait not scaling with clinically-indicated dose. Repricing PD to its measured consumable cost as a modality-neutral bundle yielded a five-year payer saving of MAD 99 million, providers solvent; the system saving foregone under parity, MAD 225 million.
CONCLUSIONS: Parity pricing leaves payer and provider indifferent to a cheaper, equivalent modality. Cutting the tariff alone is self-defeating: it reduces provider margin and can deepen under-use, since payer and provider gain in opposite directions. The lever is the structure of payment, a modality-neutral bundle or capitation, not the tariff level or modality transfer alone.
METHODS: We developed two linked models from the payer (AMO) perspective in MAD, reimbursement and real-cost bases kept separate. The first, a steady-state provider-margin model, expressed annual margin as the annualised forfait minus consumable cost at n daily exchanges, the 2L bag at the regulated hospital price. The second, a five-year PD-First budget-impact model (3% discount), reallocated 10% of incident dialysis patients to PD with technique failure (67% HD transfer, 18.5-month median survival), comparing the parity tariff with a cost-recovery bundle. Dual engines, Excel-Python reconciliation, one-way sensitivity, and 10,000-iteration probabilistic analysis validated outputs.
RESULTS: At parity, PD-First produced no five-year payer saving: the forfait equals the HD ceiling, so PD's lower cost never reaches the AMO. Provider economics were as adverse: before non-consumable costs, margin was +2,840 MAD/month at the standard CAPD dose (four exchanges/day), near zero at the automated PD mean (five cycles/night), and negative beyond, the forfait not scaling with clinically-indicated dose. Repricing PD to its measured consumable cost as a modality-neutral bundle yielded a five-year payer saving of MAD 99 million, providers solvent; the system saving foregone under parity, MAD 225 million.
CONCLUSIONS: Parity pricing leaves payer and provider indifferent to a cheaper, equivalent modality. Cutting the tariff alone is self-defeating: it reduces provider margin and can deepen under-use, since payer and provider gain in opposite directions. The lever is the structure of payment, a modality-neutral bundle or capitation, not the tariff level or modality transfer alone.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PT34
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Urinary/Kidney Disorders