Initiating Patients on Peritoneal Dialysis Compared with In-Centre Haemodialysis in the United Kingdom: A Cost-Utility and Budget Impact Analysis

OBJECTIVES: Peritoneal dialysis (PD) and haemodialysis (HD) are the principal initiating dialysis modalities for patients with kidney failure. Peritoneal dialysis is associated with early survival benefits, potential cost advantages and improved lifestyle flexibility; however, it is underutilised in the UK. This analysis aims to capture the benefits of initiating on PD compared with in-centre HD (ICHD) within UK National Health Service (NHS) practice using a cost-utility analysis (CUA) and budget impact analysis (BIA), supported by recently published UK and European renal registry data. METHODS: The CUA employed a state-transition Markov model structure to capture the cost-utility of initiating dialysis with PD versus ICHD for incident people with kidney failure over a lifetime horizon. The model captured lifetime quality-adjusted life-years (QALYs) and costs to the NHS per treatment arm. The BIA employed a budget impact model (BIM) to capture the hypothetical budget impact of increasing annual uptake of PD and home haemodialysis (HHD) at equal rates relative to current practice, with the principal objective of reaching a 20% PD prevalence within 5 years. Both models are informed by recent, UK-specific data. RESULTS: Initiating incident people with kidney failure on PD instead of ICHD resulted in 0.15 additional QALYs and £19,728 in cost savings per patient. Initiation on PD is therefore a dominant strategy, meaning that it improves health outcomes while reducing costs compared with ICHD initiation. It remains dominant across a range of scenarios and sensitivity analyses. Additionally, the UK cost savings were estimated by the BIA to be £219,866,940 over 5 years, further emphasising the financial benefits of increased PD uptake. CONCLUSIONS: Results from these analyses demonstrate that initiating patients with kidney failure on PD instead of ICHD is a dominating strategy, as it saves costs and improves health outcomes. Furthermore, they show that increasing PD uptake relative to current practice could contribute to alleviating the NHS's financial burdens, given growing demand for dialysis treatment. These comprehensive, UK-specific evaluations provide evidence of the potential benefits of increased PD within current UK clinical practice, helping to inform decisions around dialysis modality choice.