Enhancing Patient-Centred Renal Care in Slovenia: Economic and Clinical Impact of Peritoneal Dialysis Expansion

Introduction:
End-stage renal disease affects 1,008 patients per million population (pmp) in Slovenia. Despite evidence supporting peritoneal dialysis (PD) as cost-effective and patient-centred, the most recent registry data (2013) showed that only 52 of 1,401 dialysis patients (3.7%) receive PD versus 1,349 (96.3%) receiving haemodialysis (HD), representing a decline from 6% PD utilization in 2005-2012. This study examines the economic impact on the Health Insurance Institute of Slovenia (ZZZS), which managed EUR 5.25 billion in healthcare expenditure in 2024.
Methods:
We analysed PD versus HD costs from ZZZS perspective using validated European budget impact methodology (2024). Based on 2013 registry data (1,401 dialysis patients; 260 incident patients annually, 126.2 pmp), we calculated annual costs using 2024 European cost data: dialysis sessions (HD: EUR 34,574; PD: EUR 29,250), hospitalizations (HD: 7.2 days; PD: 5.0 days), healthcare personnel (HD: 15% of costs; PD: 7%), and patient transport (HD: EUR 5,860; PD: EUR 0). We assessed shifting 30% of incident HD patients (n=75) to PD, with 5-year projections.
Results:
Current utilization costs ZZZS approximately EUR 79.1 million (HD) versus EUR 2.3 million (PD) annually, with per-patient costs of EUR 58,600 (HD) versus EUR 45,000 (PD). Shifting 30% of incident patients to PD would yield first-year savings of EUR 1.02 million and cumulative 5-year savings of EUR 15.3 million. Cost reductions derive from eliminating transport costs (EUR 5,860/patient), reduced personnel requirements (8% versus 15%), and fewer hospitalizations (2.2 fewer days annually).
Conclusions:
Increasing PD from 3.7% to 30% among incident patients would represent a strategic opportunity for ZZZS to optimize resources while enhancing patient-centred care. PD enables patients to manage care at home with substantially reduced treatment burden compared to HD.Implementation would require investment in pre-dialysis education programs, improved PD catheter access, healthcare provider training in shared decision-making protocols, and ZZZS contractual frameworks incentivizing appropriate modality selection based on patient preference and clinical suitability.