{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:49:21Z","timestamp":1791499761739,"version":"4.3.4"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The increasing burden of kidney failure (KF) in India necessitates provision of cost-effective kidney replacement therapy (KRT). We assessed the comparative cost-effectiveness of initiating KRT with peritoneal dialysis (PD) or haemodialysis (HD) in the Indian context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The cost and clinical effectiveness of starting KRT with either PD or HD were measured in terms of life years (LYs) and quality-adjusted life years (QALYs) using a mathematical Markov model. Complications such as peritonitis, vascular access\u2013related complications and blood-borne infections were considered. Health system costs, out-of-pocket expenditures borne by patients and indirect costs were included. Two scenarios were considered: Scenario 1 (real-world scenario)\u2014as per the current cost and utilization patterns; Scenario 2 (public programme scenario)\u2014use in the public sector as per Pradhan Mantri National Dialysis Programme (PMNDP) guidelines. The lifetime costs and health outcomes among KF patients were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean QALYs lived per KF person with PD and HD were estimated to be 3.3 and 1.6, respectively. From a societal perspective, a PD-first policy is cost-saving as compared with an HD-first policy in both Scenarios 1 and 2. If only the costs directly attributable to patient care (direct costs) are considered, the PD-first treatment policy is estimated to be cost-effective only if the price of PD consumables can be brought down to INR70\/U.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PD as initial treatment is a cost-saving option for management of KF in India as compared with HD first. The government should negotiate the price of PD consumables under the PMNDP.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ckj\/sfab126","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T19:10:36Z","timestamp":1626289836000},"page":"128-135","source":"Crossref","is-referenced-by-count":30,"title":["Peritoneal dialysis\u2013first initiative in India: a cost-effectiveness analysis"],"prefix":"10.1093","volume":"15","author":[{"given":"Dharna","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-2446","authenticated-orcid":false,"given":"Gaurav","family":"Jyani","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Bahuguna","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Ameel","sequence":"additional","affiliation":[{"name":"National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat Bhushan","family":"Dahiya","sequence":"additional","affiliation":[{"name":"National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harbir Singh","family":"Kohli","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Prinja","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivekanand","family":"Jha","sequence":"additional","affiliation":[{"name":"The George Institute of Global Health, New Delhi, India"},{"name":"School of Public Health, Imperial College, London, UK"},{"name":"Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 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