A comparison of charges for continuous ambulatory peritoneal dialysis and center hemodialysis

Use of continuous ambulatory peritoneal dialysis (CAPD) is increasing, and it is being promoted as a less expensive alternative to center hemodialysis (CHD). The debate over the relative charges for CAPD and CHD cannot generally be answered without considering the relationship between modality selection and patient characteristics. When selection and patient characteristics are accounted for, the difference between annual charges for CAPD and CHD patients is insignificant, in part because of the current payment system. The analysis suggests that patients using CHD may have lower charges than if they were using CAPD; similarly, patients using CAPD may have lower charges than if they were using CHD. Charges during CAPD training are lower than CHD or CAPD charges. Charges during the transition between CHD and CAPD tend to be higher than either CHD or CAPD due to additional hospitalizations. Estimated results suggest that encouraging current CHD patients to transfer to CAPD (or vice versa) may not have the desired effect of reducing charges.