Caruso DM, Gray DL, Kohr JM, Gregory MW, Weiland DE, Vander
Werf BA
Cost efficiency of temporary subcutaneous implantation
of peritoneal dialysis catheter
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S73 1997
In the experience of this clinic, subcutaneous implantation of PD catheters
(Moncrief technique) with exteriorization at a subsequent operation
results in a 20% higher success rate at 1 year (85% vs. 65%) compared to PD
catheters that are exteriorized for immediate use. However, one needs also
to look at the cost issues of the second operation, and also of costs of
performing hemodialysis during the 6-week maturation period of the
subcutaneous tunnel.
Using decision tree analysis, and assuming a cost of 4.5 thousand dollars
(K) for the two operations using the Moncrief technique plus Permcath
placement vs. a cost of 2.5 thousand for standard catheter placement, and a
cost of 5K for 6 weeks of HD vs. 4K for 6 weeks of PD, and a cost of 11K
for a failed PD access, it was found that use of the Moncrief technique was
not cost effective; although catheter failure rate was reduced, overall use
of this method increased the cost of PD by $834/catheter.
Comment: This is a believable analysis, to which must be added the
costs of failed Permcaths, infected Permcaths, etc. Perhaps the Moncrief
method should be reserved for situations where PD catheters are placed
electively in patients not quite yet requiring dialysis.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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17th Annual CAPD Conference
Basic peritoneal dialysis :
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