Economic evaluation of neutral-pH, low-glucose degradation product peritoneal dialysis solutions compared with standard solutions: a secondary analysis of the balANZ Trial

Abstract

Background: Biocompatible solutions may lower peritonitis rates, but are more costly than conventional solutions. The aim of the present study was to assess the additional costs and health outcomes of biocompatible over conventional solutions in incident peritoneal dialysis patients to guide practice decisions.

Study design: Secondary economic evaluation of a randomized controlled trial.

Setting & population: 185 participants in the balANZ trial.

Model, perspective, & timeframe: Cost-effectiveness of biocompatible compared to standard solution over the 2 years using an Australian health care funder perspective.

Intervention: Intervention group received biocompatible solutions and control group received standard solutions over 2 years.

Outcomes: Costs included dialysis charges, costs of treating peritonitis, non-peritonitis-related hospital stays, and medication. Peritonitis was the health outcome of interest; incremental cost-effectiveness ratios were reported in terms of the additional cost per additional patient avoiding peritonitis at 2 years.

Results: Mean total per-patient costs were A$57,451 and A$53,930 for the biocompatible and standard-solution groups, respectively. The base-case analysis indicated an incremental cost of A$17,804 per additional patient avoiding peritonitis at 2 years for biocompatible compared to standard solution. In a sensitivity analysis excluding extreme outliers for non-peritonitis-related hospitalizations, mean per-patient costs were A$49,159 and A$52,009 for the biocompatible and standard-solution groups, respectively. Consequently, the incremental cost-effectiveness ratio also was reduced significantly: biocompatible solution became both less costly and more effective than standard solution and, in economic terms, was dominant over standard solution.

Limitations: Peritonitis was a secondary outcome of the balANZ trial. Health outcomes measured only in terms of patients avoiding peritonitis over 2 years may underestimate the longer term benefits (eg, prolonged technique survival).

Conclusions: Biocompatible dialysis solutions may offer a cost-effective alternative to standard solutions for peritoneal dialysis patients. Reductions in peritonitis-related hospital costs may offset the higher costs of biocompatible solution.

Keywords: Biocompatible; balANZ trial; cost-effectiveness; economic evaluation; end-stage kidney disease (ESKD); hospitalisation; low glucose degradation product; neutral pH; peritoneal dialysis (PD); peritoneal dialysis solutions; peritonitis.