OBJECTIVES: This study investigates the budget impact of variable distribution of adult patients experiencing unplanned start (urgent start) Peritoneal Dialysis (PD) and Haemodialysis (HD) in Brazil.

METHODS: An Excel-based budget impact model was developed to assess dialysis-associated costs when changing dialysis modalities between PD and HD from the Brazilian public payer perspective. For this exercise, as the total number of performed urgent start procedures specifically listed, we have used to estimate target population the quantity of acute renal treatment hospitalizations registered at DATASUS (Brazilian public heath database) in 2016: 23,077 hospitalizations. The analysis incorporates the current modality distribution of PD (0%) and HD (100%) and evaluates a proposal to adopt 100% PD in a one year time horizon. Complications rate from each dialysis modality came from a previously published retrospective study, where the following differences between PD and HD was found respectively: Catheter reinsertion (1% vs. 24,4%); Catheter-related infection (0% vs. 11%); Bleeding (0% vs. 3,7%); thrombosis (0% vs. 7,3%) and peritonitis (2,1% vs. 0%).

Costs of dialysis methods and complications were estimated from the official 2017 Brazilian public health care reimbursement list (SIGTAP - Sistema de Gerenciamento da Tabela do SUS). Alternative scenario included the prevalence of changing dialysis urgent start from HD to PD in order to analyse the economic impact of this adoption. As this analysis refers to an urgent procedure and in-hospital expenses, the economic impact of adoption and dialysis method-related complication reductions and was measured over 30 days of catheter insertion.

RESULTS: The change from HD to PD resulted a cumulative saving of BRL$ 3,260,135.79 for the Brazilian public health care system over a 1 year time frame.

CONCLUSIONS: This exercise shows that increasing the uptake of PD regimen could potentially reduce dialysis method-associated complications and costs for urgent start therapy in Brazil.