The Cost of Dialysis in Malaysia: Haemodialysis and Continuous Ambulatory Peritoneal Dialysis
Last reviewed: March 2026
Key Findings
- Annual cost per patient for haemodialysis (HD) ranged from RM182 to RM241 per session (mean RM206), translating to approximately RM32,000 per patient per year at three sessions weekly.
- Continuous ambulatory peritoneal dialysis (CAPD) costs ranged from RM1,400 to RM3,200 per patient month (mean approximately RM2,186/month).
- The study enrolled 90 HD patients and 73 CAPD patients from five major MOH dialysis centres across Peninsular Malaysia.
- Capital costs (land, building, equipment) were higher for HD, while consumables and hospitalisation costs were higher for CAPD, suggesting increasing CAPD as initial dialysis modality would be more cost-effective.
Background
End-stage renal disease (ESRD) represents one of the most significant chronic disease challenges facing the Malaysian healthcare system. The number of dialysis-treated ESRD patients in Malaysia has been increasing rapidly, driven by the rising prevalence of diabetes mellitus and hypertension — the two leading causes of kidney failure. According to the Malaysian Dialysis and Transplant Registry (MDTR), the acceptance rate for haemodialysis rose from 414 per million population (pmp) in 2004 to 1,097 pmp in 2015, representing nearly a threefold increase over eleven years. The total number of dialysis patients was 6,696 in public settings alone (representing 20% of the total dialysis population), with the remainder treated in private and non-governmental organisation (NGO) facilities.
Dialysis treatment consumes a disproportionately large share of healthcare resources. In Malaysia, ESRD expenditure has been estimated to constitute approximately 4.2% of total health expenditure by the public sector — a figure that is relatively high compared to other countries at similar income levels. As the dialysis population continues to grow, understanding the precise costs of different dialysis modalities is essential for healthcare planners seeking to optimise resource allocation while maintaining quality of care.
Study Design
This was a one-year prospective multicentre study conducted from October 2016 to September 2017. The study assessed direct medical costs of dialysis treatment from the Ministry of Health (MOH) perspective. Five large MOH dialysis centres were selected: Hospital Sultanah Aminah (Johor Bahru), Hospital Kuala Lumpur, Hospital Tengku Ampuan Afzan (Kuantan), Hospital Tengku Ampuan Rahimah (Klang), and Hospital Pulau Pinang. A mixed-method approach combining activity-based costing and step-down costing was employed to capture both capital and recurrent costs.
Cost Components
| Cost Category | Haemodialysis (HD) | CAPD |
|---|---|---|
| Capital costs (land, building, equipment, furnishing) | Higher | Lower |
| Staff emoluments | Higher (nurse-intensive) | Lower |
| Facility utilities | Higher (water, electricity) | Lower |
| Dialysis consumables | Lower per session | Higher (twin-bag system) |
| Hospitalisation costs | Lower | Higher (peritonitis episodes) |
| Erythropoietin (EPO) per year | ~RM4,500 | ~RM2,500 |
Haemodialysis Costs
The per-session cost of haemodialysis ranged from RM182 to RM241, with a mean cost of approximately RM206 per session. At the standard frequency of three sessions per week, this translates to an annual cost of approximately RM32,000 per patient. The major cost drivers for HD were capital expenditure (dialysis machines, water treatment systems, building infrastructure), staff costs (HD requires intensive nursing supervision throughout each 3-5 hour session), and utility costs (HD units consume substantial quantities of purified water and electricity).
CAPD Costs
CAPD costs ranged from RM1,400 to RM3,200 per patient month, with a mean of approximately RM2,186 per month. CAPD is more consumables-intensive, as patients use twin-bag dialysis solution systems requiring four exchanges daily. However, CAPD requires less capital infrastructure and significantly fewer staff, as patients perform their own dialysis at home after receiving appropriate training. Only seven private centres provided PD services to 95 PD patients at the time of the study, reflecting the relatively low uptake of peritoneal dialysis in the private sector.
Cost-Effectiveness Considerations
The study’s findings supported the case for increasing the proportion of CAPD as the initial dialysis modality for new ESRD patients. A subsequent cost-utility analysis using a Markov model demonstrated that increasing CAPD uptake from the then-current 40% to 55% or 60% would be cost-effective from the MOH perspective. The incremental cost-effectiveness ratio favoured increased CAPD utilisation, suggesting that shifting the modality mix toward peritoneal dialysis could generate significant savings without compromising patient outcomes.
The economic viability of promoting both modalities was reinforced by the finding that the cost-effectiveness of HD and CAPD were nearly equal when life-years saved were considered — HD was associated with 10.96 life-years saved versus 5.21 for CAPD. The cost per life-year saved was RM33,642 for HD and RM31,635 for CAPD, representing reasonable value by Malaysian health technology assessment standards.
Policy Implications
These cost data have informed several important policy discussions in Malaysian nephrology. The government provides a subsidy of RM100 per haemodialysis treatment, which was increased from RM50 effective January 2018. NGOs such as the National Kidney Foundation (NKF) play a crucial role in subsidising treatment costs, with NKF providing dialysis at RM170 per treatment, of which patients receiving MOH subsidy pay nothing, while the balance of RM80 is funded through NKF’s fundraising efforts.
The study’s evidence has supported the MOH’s peritoneal dialysis-first policy, which encourages suitable new ESRD patients to begin on CAPD before transitioning to HD if needed. This approach optimises the use of limited HD infrastructure while offering patients the quality-of-life benefits of home-based dialysis. The findings also highlight the need for continued investment in dialysis infrastructure and workforce development to accommodate the growing dialysis population.
Limitations
The study was conducted from the MOH perspective and therefore captured only direct medical costs borne by the public healthcare system. Indirect costs such as patient transportation, caregiver burden, and lost productivity were not assessed. The study period coincided with a depreciation of the Ringgit Malaysia (US$1 = RM4.30 in 2017), which may affect international cost comparisons. The sample of five MOH centres may not capture cost variations in private and NGO dialysis facilities. Sensitivity analysis using varying Consumer Price Index rates (2.9% per year) was conducted to address uncertainty in cost projections.
Surendra NK, Abdul Manaf MR, Hooi LS, Bavanandan S, Safhan F, Muhammad Nor MA, Shah Firdaus Khan S, Ong LM, Abdul Gafor AH. The Cost of Dialysis in Malaysia: Haemodialysis and Continuous Ambulatory Peritoneal Dialysis. Malaysian Journal of Public Health Medicine. 2018;18(2):70–81.
License: Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)