Cost-effectiveness of peritoneal dialysis catheter implantation by laparoscopy versus by open dissection

This study evaluates the cost-effectiveness of laparoscopic implantation of peritoneal dialysis (PD) catheters as compared with insertion by open dissection. The cost analysis was based on clinical experience with 232 consecutive implants and 23 procedures to rescue catheters from flow dysfunction. Institutional expenses were calculated from the costs of labor and of disposable and reusable materials. Payer costs were taken from Medicare reimbursement schedules for outpatient, inpatient, professional, and ancillary services. A break-even percentage was calculated, representing the point at which the laparoscopic procedure became cost-effective because of a lower incidence of costly catheter rescue procedures. An observed difference in the incidence of catheter obstruction between laparoscopic and open procedures exceeding this percentage would indicate that the laparoscopic approach was cost effective. The calculated break-even value varied between 1.5% and 26% depending on whether the procedures were performed exclusively on an inpatient or outpatient basis. Given our inpatient/outpatient case mix, a weighted calculation of the break-even value was 9.4%. The observed difference in incidence between the two implant methods was 10.8% overall and 16.4% for the last 91 consecutive laparoscopic procedures. The analysis demonstrates that our laparoscopic implantation procedure is a cost-effective means of establishing PD access as compared with the open dissection technique.