ANALYSIS OF THE FINANCIAL MANAGEMENT OF A PERITONEAL-DIALYSIS PROGRAMCOMPARED WITH A HEMODIALYSIS PROGRAM

In order to aid decision-making in health care there is an increasing interest in the analysis of cost-effectiveness of treatments of end-st age renal diseases. The aim of the study was to analyse the cost of co ntinuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) i n the renal unit of a community hospital covering an area with 317,000 inhabitants. The study was carried out in 1994. There were 27 current patients on CAPD and 84 on HD. HD session were performed with cellulo se acetate filters and in 80% of patients with bicarbonate. The follow ing data were recorded: the cost of CAPD out-patients visits, the cost of HD sessions and routine follow-ups, admissions, transportation, an d erythropoietin (EPO-rHu) treatment. We considered the total cost inc luding the structural and financial costs. The reimbursement to the ho spital for the HD program was divided into 92.5% for the HD sessions, 6.3% for admissions and 1.2% for out-patient care. Only 24% of the rei mbursement of the CAPD programme was provided for the technique, 28% w as for the admissions and 48% for out-patient care. The cost of transp ortation and EPO-rHu treatment on HD was respectively 40 and 2.6 times greater than that of CAPD. The annual saving cost of CAPD per patient was 529,087. In conclusion, CAPD is a more cost efficient technique t han HD for our public health system, fundamentally because of a saving in transportation and EPO-rHU treatment. The way CAPD is financed doe s not encourage its use in hospitals, and a modification of the reimbu rsement is needed for the development of CAPD.