Quality-adjusted survival and costs of dialysis modalities in Poland: a lifetime model evaluation

Abstract Background and Hypothesis Chronic kidney disease (CKD) affects approximately 4.7 million people in Poland, with around 21,000 patients requiring renal replacement therapy. Among these patients, hemodialysis (HD) is the most commonly used treatment modality. Despite clinical guidelines emphasizing the medical and economic advantages of peritoneal dialysis (PD), its use remains limited. We hypothesize that PD is a more cost-effective option than in-center HD for patients initiating dialysis in Poland. This study aims to evaluate and compare the cost-effectiveness of these two dialysis modalities. Methods We conducted a systematic literature review to compare survival and quality-of-life outcomes between peritoneal dialysis and hemodialysis. We performed a cost-utility analysis using a Markov model from the perspective of the Polish National Health Fund. The model included three health states—dialysis, post-transplant, and death—and applied a lifetime horizon. Health outcomes were expressed as quality-adjusted life years (QALYs), and cost inputs were derived from national reimbursement data. Results PD yielded 4.98 QALYs, compared with 4.54 QALYs for in-center HD. The total cost of PD was 569,167 PLN/133,294 EUR/153,829 USD, compared with 478,710 PLN/112,110 EUR/129,381 USD for HD. The incremental cost-utility ratio (ICUR) was 208,489 PLN/48,826 EUR/56,348 USD per QALY, falling below the Polish cost-effectiveness threshold. PD was also associated with lower hospitalization rates and reduced costs related to complications and mortality. Deterministic sensitivity analyses further support these findings across multiple scenarios. The probabilistic sensitivity analysis indicated moderate decision uncertainty, with PD being cost-effective in 54.4% of simulations at the applied willingness-to-pay threshold. Conclusion The model results indicate that peritoneal dialysis is likely to be a cost-effective alternative to in-center hemodialysis in Poland. PD was associated with higher costs and greater effectiveness than in-center HD, resulting in an ICUR below the Polish cost-effectiveness threshold in the base-case analysis. While the findings are limited by available evidence, they suggest that peritoneal dialysis may offer clinical benefits for appropriately selected patients. The results support consideration of strategies to improve access to PD and may inform healthcare policy aimed at expanding patient choice and optimizing resource allocation. Policy initiatives focused on reimbursement, education, and informed modality choice may facilitate greater access to PD while maintaining an individualized approach to dialysis modality selection.