OBJECTIVES: Chronic Kidney Disease (CKD) is a condition of altered renal function persisting for more than 3 months. The fifth and final stage of CKD, also known as end-stage renal disease (ESRD), occurs when there is a complete loss of renal function, so patients require renal replacement therapies. The project aims to compare, through a Health Technology Assessment (HTA), the clinical pathway of peritoneal dialysis (PD) with inpatient hemodialysis (HD).

METHODS: The HTA report followed the EUnetHTA Core Model® (version 3.0) methodology. Through a literature review, epidemiological aspects of CKD, management of patients with stage 5 CKD, and technical, efficacy, and safety characteristics of PD and HD were identified. The report presents two analyses: a budget impact analysis (BIA), and a cost-utility analysis (CUA) based on a 4-cycle Markov model. The Activity Based Costing approach was used to develop both analyses, considering either the social or National Health Service (NHS) perspective.

RESULTS: The literature review yielded 74 relevant studies. In Italy, in 2019, the incidence and prevalence level for CKD was identified as 16.2 and 81.1 per 100,000 population, respectively. A PD and HD utilization rate of 14.3% and 84.3% were also reported, respectively. Safety and efficacy analyses showed no significant differences between PD and HD. The BIA indicated potential savings per patient of € 274.87 at 5 years with an increased PD utilization. CUA’s findings showed that PD is the dominant management strategy compared with HD. These results emerged in both perspectives under analysis and were considered robust based on the sensitivity analyses conducted.

CONCLUSIONS: Optimizing the use of PD over HD in stage 5 CKD patients in Italy could lead to improved resource allocation. From a societal perspective, this optimization could result in higher income levels, productivity savings, and improved quality of life for patients and their families.