OBJECTIVES : To estimate the costs of peritoneal dialysis (PD) and hemodialysis (HD) from the Social Security and Ministry of Health perspective in Paraguay.

METHODS : An Excel®-based Markov model was developed to analyze costs of PD and HD in a hypothetical cohort of 320 prevalent patients. In this model patients transited through four health states (controlled disease, ambulatory complication, inpatient care complication and death) in monthly cycles during a one year time horizon. Transition probabilities were estimated from literature reported complications and death rates. Health states costs were estimated from Social Security, Ministry of Health and Health Care providers 2017 reference tariffs and consumptions for medical devices, medications, equipment, diagnosis, overheads, professional services and complications. One way deterministic sensitivity analysis was performed to analyze uncertainty around complication rates and complication costs, considering that there is a lack of local information around these variables. Cost were reported in Paraguayan Guaranies PYG (USD 1 = PYG 5,555 Nov 2017). Discount rate was not required.

RESULTS : Form the Social Security perspective, total cost for HD and PD were PYG 39,974,242,026 and PYG 34,791,447,953 respectively. From the Ministry of Health Perspective, total cost for HD and PD were PYG 38,662,078,185 and PYG 34,791,447,952 respectively. In case the HD services were outsourced to private dialysis providers, the HD total cost estimated was PYG 44,354,588,906. The PD modality continued to be a cost saving modality in the one way deterministic sensitivity analysis.

CONCLUSIONS : The PD modality is a cost saving alternative for Social Security and Ministry of Health in Paraguay. Savings are explained mainly in terms of less professional services intensity, less overheads fixed costs, less medication requirement and potentially less complications.