Observations that peritoneal dialysis (PD) may be an effective, lower-cost alternative to hemodialysis for the treatment of ESKD have led to policies encouraging PD and subsequent increases in its use in the United States.

In a retrospective cohort analysis of Medicare beneficiaries who started dialysis between 2008 and 2015, we ascertained average annual expenditures (for up to 3 years after initiation of dialysis) for patients ≥67 years receiving in-center hemodialysis or PD. We also determined whether differences in Medicare expenditures across dialysis modalities persisted as more patients were placed on PD. We used propensity scores to match 8305 patients initiating PD with 8305 similar patients initiating hemodialysis.

Overall average expenditures were US$108,656 (2017) for hemodialysis and US$91,716 for PD (proportionate difference, 1.11; 95% confidence interval [CI], 1.09 to 1.13). This difference did not change over time (P for time interaction term=0.14). Hemodialysis had higher estimated intravenous (iv) dialysis drug costs (1.69; 95% CI, 1.64 to 1.73), rehabilitation expenditures (1.35; 95% CI, 1.26 to 1.45), and other nondialysis expenditures (1.34; 95% CI, 1.30 to 1.37). Over time, initial differences in total dialysis expenditures disappeared and differences in iv dialysis drug utilization narrowed as nondialysis expenditures diverged. Estimated iv drug costs declined by US$2900 per patient-year in hemodialysis between 2008 and 2014 versus US$900 per patient-year in PD.

From the perspective of the Medicare program, savings associated with PD in patients ≥67 years have remained unchanged, despite rapid growth in the use of this dialysis modality. Total dialysis expenditures for the two modalities converged over time, whereas nondialysis expenditures diverged.

腹膜透析 (PD) 可能是血液透析治疗 ESKD 的一种有效且成本较低的替代方法，这一观察结果促使美国出台了鼓励 PD 的政策，并随后增加了它的使用。

在对 2008 年至 2015 年间开始透析的医疗保险受益人的回顾性队列分析中，我们确定了接受中心血液透析或 PD 的 ≥67 岁患者的平均年支出（透析开始后长达 3 年）。我们还确定了随着更多患者接受 PD，透析方式的医疗保险支出差异是否持续存在。我们使用倾向评分将 8305 名开始 PD 的患者与 8305 名开始血液透析的相似患者进行匹配。

血液透析的总体平均支出为 108,656 美元（2017 年），PD 为 91,716 美元（比例差异，1.11；95% 置信区间 [CI]，1.09 至 1.13）。这种差异不随时间变化（时间交互项的P = 0.14）。血液透析具有较高的估计静脉 (iv) 透析药物成本（1.69；95% CI，1.64 至 1.73）、康复支出（1.35；95% CI，1.26 至 1.45）和其他非透析支出（1.34；95% CI，1.30 至 1.30） 1.37). 随着时间的推移，总透析费用的初始差异消失，并且随着非透析费用的不同，静脉透析药物使用的差异缩小。2008 年至 2014 年间，血液透析中每患者每年的静脉药物成本估计下降了 2900 美元，而 PD 中每患者每年下降了 900 美元。

从 Medicare 计划的角度来看，尽管使用这种透析方式的人数迅速增加，但 ≥ 67 岁患者与 PD 相关的储蓄保持不变。随着时间的推移，两种方式的透析总支出趋于一致，而非透析支出则出现分歧。