How much extra does "adequate" peritoneal dialysis cost?

Our objective was to investigate the extra cost associated with implementing an adequacy program in peritoneal dialysis (PD) and to evaluate the cost effectiveness of a variety of PD prescriptions. This was a cross-sectional study of all 37 patients attending the PD clinic at a university teaching hospital. Extra costs incurred on dialysate, tubing, and cyclers as a consequence of implementing an adequacy program in PD were measured. Costs per unit KT/V for a variety of PD prescriptions were also calculated. Thirteen patients (35%) required an alteration in prescription for adequacy reasons. The average extra costs incurred for all patients was Cdn. $2,323 per annum, which represents a 16% increase per patient. The most cost-effective prescriptions were high volume continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) with two daytime dwells. The least cost-effective prescriptions were day dry APD and high volume APD with only one daytime dwell. Significant extra expense is incurred when an adequacy program is implemented in PD. This is mainly due to the requirement to put more patients on APD. An alternative pricing policy for PD is suggested.