For our purposes, PD includes both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), while HD includes either in-centre HD or hospital HD (but not home HD). CAPD is offered only in a few centres in the country and is not completely covered by the health insurance scheme. Machines will be leased to local doctors. Baxter. However, we present some insight into some factors that might contribute to this variability. Baxter, Ambu-Flex, and Dianeal are trademarks of Baxter International Inc. Store at room temperature (77° F) and in moisture barrier overwrap and in carton until ready for use. Another advantage connected to PD is that it is not as dependent on infrastructure and geography as HD is. The government of Singapore offers the same reimbursement for both modalities. Too much fear? Any local manufacturing? Furthermore, currency values are influenced by inflating prices; by using the HD/PD cost ratio, we overcome the difficulties implied by adjusting for inflation. The catheter insertion is done by a general surgeon in most of the cases. (complications and non-medical economic implications were not considered in the calculations in order to avoid biased estimates). What is the current reimbursement policy for HD and PD? In continuation, we will thus consider HD and PD as perfect substitutes from an economic standpoint. It has been observed that the market for CAPD bags in most countries is monopolistic; this tends to drive up market prices. A thorough literature survey of EMBASE and PUBMED was conducted; 78 articles which compared the annual PD and annual HD costs were finally selected. [13] in 2004, the HD/PD ratio in Turkey is ∼1.16. The overall PMP is 503, with 320 being the HD PMP and 183 being the PD PMP [1]. From 2003–2007, the number of PD patients increased by almost 20%, while the increase in the number of HD patients was only ∼5.5%. Some countries had multiple studies conducted on PD and HD costs. As we have shown before, market factors seem to play a major role in PD utilization. On average, this group of countries has an overall dialysis PMP of 377 (280 HD and 97 PD) and therefore a high PD utilization rate of 26% [7]. Costa Rica and Colombia also have much higher PD utilization rates than the world average, with 48 and 37% [1], respectively. This is confirmed by the United States renal data system (USRDS) 2012 Annual Report, which adjusted for all possible patient characteristics [2] including age, sex, race, ethnicity and primary diagnosis. Thailand has recently implemented a PD first policy, and PD utilization is growing rapidly. (r and P result from Pearson's correlations). In order to highlight such differences in methodology, we classified studies into three broad categories depending on the comprehensiveness of the cost analysis. We found that these concerns were further complicated by the variability of the data compared between individual reports and by incomplete transparency. It is clear from our results that the HD/PD cost ratio varies significantly across countries. Another example from the literature is an abstract by Chen et al. In the end, PD utilization can be effectively promoted by governments; some examples include the implementation of a PD first programme (as was done by Thailand recently), the encouragement of local manufacturing or production of CAPD bags (done by India over the last decade) and the slashing of import duties on CAPD bags (as has been done in Nepal and Malaysia).

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