Laparoscopic versus open peritoneal dialysis catheter insertion cost analysis.

Area of Science:

• Nephrology
• Surgical Innovation
• Health Economics

Background:

• Peritoneal dialysis (PD) offers a cost-effective alternative to hemodialysis (HD).
• Traditional PD catheter insertion uses open incisions, but laparoscopic visualization is gaining popularity due to reduced catheter malfunction.
• This study compares the cost-effectiveness of laparoscopic versus open PD catheter insertion.

Purpose of the Study:

• To compare the total annual costs of laparoscopic versus open PD catheter insertion.
• To evaluate the impact of postoperative complications and salvage procedures on overall costs.
• To determine the value of laparoscopic insertion in initiating PD.

Main Methods:

• A decision analysis model simulated one-year outcomes for both insertion methods.
• Outcomes included catheter function, infection, and malfunction, leading to continued PD or switch to HD.
• Literature review determined baseline probabilities, costs, and ranges, with sensitivity analyses performed.

Main Results:

• Total annual costs were $69,491 for laparoscopic and $69,960 for open insertion.
• Fluoroscopy-guided wire manipulation was less costly for salvage than laparoscopic repositioning.
• Laparoscopic insertion demonstrated potential for lower total costs despite initial expenses.

Conclusions:

• Laparoscopic PD catheter insertion can be more cost-effective than open insertion for experienced surgeons.
• Fewer postoperative complications associated with laparoscopic visualization contribute to lower total costs.
• Laparoscopic insertion is a valuable, cost-effective tool for initiating PD, aligning with healthcare cost-containment goals.