Global Cost Comparison of Hemodialysis and Peritoneal Dialysis in End-Stage Kidney Disease: A Systematic Review Across Country Income Levels
Article Sidebar
Main Article Content
Page: 1405-1418
Abstract
The increasing prevalence of end-stage renal disease poses an economic challenge to healthcare systems worldwide. Hemodialysis and peritoneal dialysis are currently the most commonly used renal replacement therapy modalities, but their costs vary across components and economic contexts. This systematic review aims to compare the costs of hemodialysis and peritoneal dialysis across countries, considering income levels and economic perspectives. A systematic literature search was conducted using EBSCO, ProQuest, PubMed, Scopus, and SpringerLink databases, with studies conducted between 2015 and 2025. Studies reporting cost analyses of hemodialysis and/or peritoneal dialysis were included. The selection process followed PRISMA guidelines, and the methodology was assessed using the CHEERS 2022 checklist. A total of 33 studies were included for discussion across low- to high-income levels. Economically, peritoneal dialysis was found to be more cost-effective than hemodialysis in most of these studies. The difference in cost structure is attributed to direct medical costs, which constitute the largest component of costs. Hemodialysis treatment is more expensive due to the costs of dialysis machines, service facilities, labor, and infrastructure, as well as lost productivity and indirect medical costs. Advantages of peritoneal dialysis include lower transportation costs, reduced productivity loss, and accessibility to low- and middle-income countries. Several studies have also shown that peritoneal dialysis yields quality-adjusted life years (QALYs) comparable to hemodialysis. This systematic review concludes that peritoneal dialysis can be cost-effective in most high-income countries. It should be considered a treatment modality of choice to improve efficiency, control long-term costs, and support health insurance management.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
World Health Organization, "The top 10 causes of death," World Health Organization.
B. Bikbov et al., "Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017," The Lancet, vol. 395, no. 10225, pp. 709–733, Feb. 2020, doi: 10.1016/S0140-6736(20)30045-3. DOI: https://doi.org/10.1016/S0140-6736(19)32977-0
C. P. Kovesdy, "Epidemiology of chronic kidney disease: an update 2022," Apr. 01, 2022, Elsevier B.V. doi: 10.1016/j.kisu.2021.11.003. DOI: https://doi.org/10.1016/j.kisu.2021.11.003
M. Ali, A. Ejaz, H. Iram, S. A. Solangi, A. M. Junejo, and S. A. Solangi, "Frequency of Intradialytic Complications in Patients of End-Stage Renal Disease on Maintenance Hemodialysis," Cureus, Jan. 2021, doi: 10.7759/cureus. 12641. DOI: https://doi.org/10.7759/cureus.12641
R. Andika, D. M. M. P. Hutajulu, and E. J. Nelwan, "Perbandingan Hemodialisis dan Continuous Ambulatory Peritoneal Dialysis terhadap Kualitas Hidup," eJournal Kedokteran Indonesia, p. 281, Dec. 2023, doi: 10.23886/ejki.11.470.281. DOI: https://doi.org/10.23886/ejki.11.470.281
United States Renal Data System, "2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States," 2023.
NIHR Evidence, "Dialysis for kidney failure: Evidence to improve care." National Institute for Health and Care Research.
T. Tjahjodjati, Y. Kuddah, and Z. Wijayanti, "Continuous Ambulatory Peritoneal Dialysis Cost-Effectiveness in National Health Insurance Era of Indonesia,” Majalah Kedokteran Bandung, vol. 55, no. 4, pp. 260–263, Dec. 2023, doi: 10.15395/mkb.v55n4.2372. DOI: https://doi.org/10.15395/mkb.v55n4.2372
A. Schreide, C. S. de M. Júnior, and N. M. da S. Fernandes, “download (1),” vol. 44(2):204-214, Jan. 2022, doi: https://doi.org/10.1590/2175-8239-JBN-2021-0118. DOI: https://doi.org/10.1590/2175-8239-jbn-2021-0118
A. M. Brabo, D. B. Dias, E. N. da Silva, and D. Ponce, “download,” Brazilian Journal of Nephrology, vol. 47(1):e20240051, Jan. 2025, doi: 10.1590/2175-8239-JBN-2024-0051en. DOI: https://doi.org/10.1590/2175-8239-jbn-2024-0051pt
A. Beaudry, T. W. Ferguson, C. Rigatto, N. Tangri, S. Dumanski, and P. Komenda, “Cost of dialysis therapy by modality in Manitoba,” Clinical Journal of the American Society of Nephrology, vol. 13, no. 8, pp. 1197–1203, Aug. 2018, doi: 10.2215/CJN.10180917. DOI: https://doi.org/10.2215/CJN.10180917
H. Wu, Q. Li, Y. Cai, J. Zhang, W. Cui, and Z. Zhou, “Economic burden and cost-utility analysis of three renal replacement therapies in ESRD patients from Yunnan Province, China,” Int. Urol. Nephrol., vol. 52, no. 3, pp. 573–579, Mar. 2020, doi: 10.1007/s11255-020-02394-1. DOI: https://doi.org/10.1007/s11255-020-02394-1
Z. Hong et al., “Economic evaluation of three dialysis methods in patients with end-stage renal disease in China,” Int. Urol. Nephrol., vol. 55, no. 5, pp. 1247–1254, May 2023, doi: 10.1007/s11255-022-03402-2. DOI: https://doi.org/10.1007/s11255-022-03402-2
J. Liu et al., “Financial implications of dialysis modalities in the developing world: A Chinese perspective,” Peritoneal Dialysis International, vol. 40, no. 2, pp. 193–201, Mar. 2020, doi: 10.1177/0896860819893812. DOI: https://doi.org/10.1177/0896860819893812
X. Ma et al., “Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study,” Ren. Fail., vol. 43, no. 1, pp. 754–765, 2021, doi: 10.1080/0886022X.2021.1918164. DOI: https://doi.org/10.1080/0886022X.2021.1918164
A. Van Der Tol et al., “A call for harmonization of European kidney care: Dialysis reimbursement and distribution of kidney replacement therapies,” Nephrology Dialysis Transplantation, vol. 35, no. 6, pp. 979–986, Jun. 2020, doi: 10.1093/ndt/gfaa035. DOI: https://doi.org/10.1093/ndt/gfaa035
T. A. Baye, H. Gebeyehu, M. Bekele, S. Abdelmenan, T. A. Ashengo, and B. Mengistu, “The economic burden of hemodialysis and associated factors among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia,” Cost Effectiveness and Resource Allocation, vol. 22, no. 1, Dec. 2024, doi: 10.1186/s12962-024-00530-7. DOI: https://doi.org/10.1186/s12962-024-00530-7
A. Shukri et al., “Hemodialysis and Peritoneal Dialysis in Germany from a Health Economic View—A Propensity Score Matched Analysis,” Int. J. Environ. Res. Public Health, vol. 19, no. 21, Nov. 2022, doi: 10.3390/ijerph192114007. DOI: https://doi.org/10.3390/ijerph192114007
C. Ntais, K. Loizou, C. Panagiotakis, N. Kontodimopoulos, and J. Fanourgiakis, “Cost Analysis of End-Stage Renal Disease in Pediatric Patients in Greece,” Healthcare (Switzerland), vol. 12, no. 20, Oct. 2024, doi: 10.3390/healthcare12202074. DOI: https://doi.org/10.3390/healthcare12202074
C. K. H. Wong et al., “Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis,” Nephrology Dialysis Transplantation, vol. 34, no. 9, pp. 1565–1576, Sep. 2019, doi: 10.1093/ndt/gfy395. DOI: https://doi.org/10.1093/ndt/gfy395
K. Pandiyambakkam Rajendran, R. Anbazhagan, S. Ramalingam, S. Rajamohan, and S. Govindarajulu, “A cross-sectional study to assess the health-related quality of life of patients on haemodialysis in Chennai,” Egypt. J. Intern. Med., vol. 36, no. 1, Sep. 2024, doi: 10.1186/s43162-024-00356-y. DOI: https://doi.org/10.1186/s43162-024-00356-y
D. Gupta et al., “Peritoneal dialysis-first initiative in India: a cost-effectiveness analysis,” Clin. Kidney J., vol. 15, no. 1, pp. 128–135, Jan. 2022, doi: 10.1093/ckj/sfab126. DOI: https://doi.org/10.1093/ckj/sfab126
S. Putri et al., “Supporting dialysis policy for end-stage renal disease (ESRD) in Indonesia: an updated cost-effectiveness model,” BMC Res. Notes, vol. 15, no. 1, Dec. 2022, doi: 10.1186/s13104-022-06252-4. DOI: https://doi.org/10.1186/s13104-022-06252-4
Afiatin et al., “Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia,” PLoS One, vol. 12, no. 5, May 2017, doi: 10.1371/journal.pone.0177436. DOI: https://doi.org/10.1371/journal.pone.0177436
H. Omranikhoo, S. Shabani, A. Esfandiari, H. Salari, and M. Rezaee, “Economic burden of end-stage renal disease: a case study in southern Iran,” Health Econ. Rev., vol. 15, no. 1, Dec. 2025, doi: 10.1186/s13561-025-00647-2. DOI: https://doi.org/10.1186/s13561-025-00647-2
A. Moradpour, M. Hadian, and M. Tavakkoli, “Economic evaluation of End Stage Renal Disease treatments in Iran,” Clin. Epidemiol. Glob. Health, vol. 8, no. 1, pp. 199–204, Mar. 2020, doi: 10.1016/j.cegh.2019.07.001. DOI: https://doi.org/10.1016/j.cegh.2019.07.001
M. Yousefi, A. A. Arani, B. Sahabi, A. Kazemnejad, and S. Fazaeli, “Household Health Costs: Direct, Indirect and Intangible,” 2014. [Online]. Available: http://ijph.tums.ac.ir
J. Kim et al., “Budget impact analysis of the change in peritoneal dialysis use rate in Korea,” Peritoneal Dialysis International, vol. 39, no. 6, pp. 547–552, Nov. 2019, doi: 10.3747/pdi. 2018.00037. DOI: https://doi.org/10.3747/pdi.2018.00037
M. Aoun, E. Helou, G. Sleilaty, R. M. Zeenny, and D. Chelala, “Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives,” BMC Health Serv. Res., vol. 22, no. 1, Dec. 2022, doi: 10.1186/s12913-022-07936-0. DOI: https://doi.org/10.1186/s12913-022-07936-0
N. Kumar Surendra, M. Rizal Abdul Manaf, and L. Seong Hooi Hospital Sultanah Aminah Johor Bahtu, “The Cost of Dialysis in Malaysia: Haemodialysis and Continuous Ambulatory Peritoneal Dialysis,” 2018. [Online]. Available: https://www.researchgate.net/publication/336642537
N. K. Surendra et al., “Cost utility analysis of end-stage renal disease treatment in Ministry of Health dialysis centres, Malaysia: Hemodialysis versus continuous ambulatory peritoneal dialysis,” PLoS One, vol. 14, no. 10, Oct. 2019, doi: 10.1371/journal.pone.0218422. DOI: https://doi.org/10.1371/journal.pone.0218422
Y. A. Agada-Amade, D. C. Ogbuabor, E. Obikeze, E. Eborieme, and O. E. Onwujekwe, “Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria,” BMC Nephrol., vol. 25, no. 1, Dec. 2024, doi: 10.1186/s12882-024-03459-4. DOI: https://doi.org/10.1186/s12882-024-03459-4
S. Behlul and M. Artac Ozdal, “Risk of COVID-19 and Cost Burden in End-Stage Renal Disease Patients and Policy Implications for Managing Nephrology Services during the COVID-19 Pandemic,” Healthcare (Switzerland), vol. 10, no. 12, Dec. 2022, doi: 10.3390/healthcare10122351. DOI: https://doi.org/10.3390/healthcare10122351
I. Moreno Velásquez et al., “End-stage renal disease-financial costs and years of life lost in Panama: A cost-Analysis study,” BMJ Open, vol. 9, no. 5, May 2019, doi: 10.1136/bmjopen-2018-027229. DOI: https://doi.org/10.1136/bmjopen-2018-027229
A. R. Villanueva et al., “Cost-of-illness analysis of chronic kidney disease (CKD) management in the Philippines,” J. Med. Econ., vol. 28, no. 1, pp. 494–507, 2025, doi: 10.1080/13696998.2025.2481766. DOI: https://doi.org/10.1080/13696998.2025.2481766
C. Nemzoff et al., “Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda,” Cost Effectiveness and Resource Allocation, vol. 22, no. 1, Dec. 2024, doi: 10.1186/s12962-024-00545-0. DOI: https://doi.org/10.1186/s12962-024-00545-0
E. Thsehla, M. K. Boachie, and S. Goldstein, “Cost-effectiveness and budget impact analysis of peritoneal dialysis and haemodialysis in South Africa,” BMC Health Serv. Res., vol. 25, no. 1, Dec. 2025, doi: 10.1186/s12913-025-12227-5. DOI: https://doi.org/10.1186/s12913-025-12227-5
L. Makhele, M. Matlala, M. Sibanda, A. P. Martin, and B. Godman, “A Cost Analysis of Haemodialysis and Peritoneal Dialysis for the Management of End-Stage Renal Failure At an Academic Hospital in Pretoria, South Africa,” Pharmacoecon. Open, vol. 3, no. 4, pp. 631–641, Dec. 2019, doi: 10.1007/s41669-019-0124-5. DOI: https://doi.org/10.1007/s41669-019-0124-5
G. Barbado, C. Garí, A. Ariznavarreta, N. Vidal-Vilar, and C. Alvarez, “Budgetary impact of increasing use of peritoneal dialysis over haemodialysis in Spain,” Dec. 01, 2025, BioMed Central Ltd. doi: 10.1186/s13561-025-00633-8. DOI: https://doi.org/10.1186/s13561-025-00633-8
C. H. Tang et al., “Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan,” BMJ Open, vol. 9, no. 3, Mar. 2019, doi: 10.1136/bmjopen-2018-023062. DOI: https://doi.org/10.1136/bmjopen-2018-023062
M. Assanatham et al., “Economic evaluation of peritoneal dialysis and hemodialysis in the Thai population with End-stage Kidney Disease,” BMC Health Serv. Res., vol. 22, no. 1, Dec. 2022, doi: 10.1186/s12913-022-08827-0. DOI: https://doi.org/10.1186/s12913-022-08827-0