Hemodialysis and Peritoneal Dialysis in Germany from a Health Economic View—A Propensity Score Matched Analysis

Abstract

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are deemed medically equivalent for therapy of end-stage renal disease (ESRD) and reimbursed by the German statutory health insurance (SHI). However, although the home dialysis modality PD is associated with higher patient autonomy than HD, for unknown reasons, PD uptake is low in Germany. Hence, we compared HD with PD regarding health economic outcomes, particularly costs, as potentially relevant factors for the predominance of HD. Methods: Claims data from two German health insurance funds were analysed in a retrospective cohort study regarding the prevalence of HD and PD in 2013–2016. Propensity score matching created comparable HD and PD groups (n = 436 each). Direct annual health care costs were compared. A sensitivity analysis included a comparison of different matching techniques and consideration of transportation costs. Additionally, hospitalisation and survival were investigated using Poisson regression and Kaplan-Meier curves. Results: Total direct annual average costs were higher for HD (€47,501) than for PD (€46,235), but not significantly (p = 0.557). The additional consideration of transportation costs revealed an annual cost advantage of €7000 for PD. HD and PD differed non-significantly in terms of hospitalisation and survival rates (p = 0.610/p = 0.207). Conclusions: PD has a slight non-significant cost advantage over HD, especially when considering transportation costs.

Center Hemodialysis Versus Peritoneal Dialysis: A Cost-Utility Analysis

“…The majority of studies included patients from Europe. The patient collective is similar to the German collective [8].…”

“…Data regarding mortality and healthcare costs, including transportation, were extracted from a paper by Shukri et al [8]. They analyzed claims data from two large German health insurance companies.…”

Impact of Different Types of Social Support on the Health of Rural Chinese Residents: Based on the Data of the 2020 China Family Panel Studies

“…When studying mental and physical health associated with interpersonal violence, PSM was used to select a control group similar to the victim at risk, thereby excluding bias from comparison with the general population [10]. In a health economics study, which concluded that randomization was not possible in retrospective cohort studies, matching techniques such as PSM provided an alternative to generating comparable groups by adjusting for observed confounding factors [11]. In examining the relationship between cancer in adolescents and their healthy quality of life, PSM was used to control for predisposing and contributing factors [12].…”