OBJECTIVE:Conventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. In the present prospective assessment, we describe the resources used and total patient costs for both HD and PD. ♢ METHODOLOGY:We assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. The information was collected at three points over 1 year, using standard questionnaires. The sources for costs were the Brazilian public and private health care systems. Societal perspective was considered. ♢ STATISTICAL ANALYSIS:Core trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year. ♢ RESULTS:Of the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. The mean age for women was 55.8 years; for men, it was 59.8 years (p = 0.001). The average total cost per patient-year was US$28 570 for HD and US$27 158 for PD. By category, the costs consisted of direct medical-hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts (p = 0.025). ♢ CONCLUSIONS:Maintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.

译文

目的:常规血液透析(HD)优于全世界的腹膜透析(PD)。缺乏比较这些方式成本的前瞻性和比较性研究。在当前的前瞻性评估中,我们描述了HD和PD的资源使用和患者总费用。 ♢
方法:我们评估了249例HD患者和228例PD患者。所有患者年龄均在18岁或以上,并且透析稳定。使用标准调查表在1年中的3个时间点收集了该信息。费用来源是巴西的公共和私人卫生保健系统。考虑了社会视角。 ♢
统计分析:测量核心趋势和离散度。回归模型评估了模态对每位患者每年平均总费用的影响。 ♢
结果:在249例HD患者和228例PD透析患者中​​,分别完成了189例(74%)和160例(70%)随访。女性的平均年龄为55.8岁;男性为59.8岁(p = 0.001)。 HD患者每位患者每年的平均总费用为28 570美元,PD患者为27 158美元。按类别,这些费用包括直接医疗-医院费用(HD的82.3%,PD的86.5%),直接非医疗费用(HD的5.3%,PD的3.7%)和间接费用(HD的12.4%,9.8%)对于PD)。 PD患者的总费用比HD患者低(p = 0.025)。 ♢
结论:维持性透析是这两种方式最重要的费用来源。生产力的损失导致了巨大的成本。未来的研究应考虑每种方式产生的社会后果。

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