Cost savings from peritoneal dialysis therapy time extension using icodextrin

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Medical Economics

Background:

• Refractory fluid overload (RFO) often necessitates conversion from peritoneal dialysis (PD) to hemodialysis (HD).
• PD therapy is generally more cost-effective than HD in Australia.
• Icodextrin has shown potential in retrospective studies to prolong PD treatment duration.

Purpose of the Study:

• To prospectively investigate if icodextrin can prolong PD technique survival in RFO patients.
• To estimate the cost savings associated with using icodextrin to delay HD initiation.
• To assess the impact of icodextrin on peritoneal ultrafiltration in RFO patients.

Main Methods:

• Prospective, open-label study of 39 RFO patients.
• Patients received icodextrin, and time to conversion to HD was measured.
• A computer model estimated cost savings based on regional PD and HD therapy costs.

Main Results:

• Icodextrin significantly increased daily peritoneal ultrafiltration by a median of 368 mL.
• PD technique survival was prolonged by a mean of 1.21 years.
• Patients with ultrafiltration failure (UFF) experienced a mean extension of 1.70 years.
• Annualized cost savings were US$3,683 per patient, rising to US$4,893 for UFF patients.

Conclusions:

• Icodextrin effectively prolongs PD technique survival in RFO patients.
• This allows patients to continue their preferred PD therapy.
• The use of icodextrin in RFO patients is highly cost-effective in Australia, particularly for those with UFF.