Starting Dialysis on Time, At Home on the Right Therapy (START): Cost analysis of an initiative to increase the use of peritoneal dialysis

Home-based peritoneal dialysis (PD) is less resource-intensive than in-center hemodialysis. When provided with a choice, many patients prefer home-based therapies. The Starting Dialysis on Time, At Home on the Right Therapy (START) project was a quality improvement initiative aiming to increase PD use in Alberta, Canada. The START project provided site-specific audit and feedback reports on the processes of care for PD and increased the use of PD. In this current study, we conducted a retrospective cost analysis of the START project. We used the perspective of a publicly funded healthcare system to compare the costs before and after the START intervention. We used a decision analytic model stratifying the patient cohort by age (under and over 65 years) and estimated the impact of the START intervention on the overall cost of care at 1, 3, 5, and 10 years. Sensitivity analyses were performed. We found cost savings of $CAD 1.2 million, $CAD 1.9 million, $CAD 2.4 million, and $CAD 2.7 million for the START intervention at 1, 3, 5, and 10 years, respectively. Results were robust to a variety of sensitivity and scenario analyses. Even modest increases in PD utilization led to cost savings. We found that the implementation of a quality improvement initiative to increase PD resulted in substantial cost savings over time.