Original Investigations: Dialysis Therapies
Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access*,**,,★★

https://doi.org/10.1053/ajkd.2002.34924Get rights and content

Abstract

Background: Care of patients with end-stage renal disease (ESRD) is important and resource intense. To enable ESRD programs to develop strategies for more cost-efficient care, an accurate estimate of the cost of caring for patients with ESRD is needed. Methods: The objective of our study is to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and contrast differences in resources required for various dialysis modalities. One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospectively for 1 year. Detailed information on baseline patient characteristics, including comorbidity, was collected. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. We also estimated separately the cost of maintaining the dialysis access. Results: Overall annual cost of care for in-center, satellite, and home/self-care hemodialysis and peritoneal dialysis were US $51,252 (95% confidence interval [CI], 47,680 to 54,824), $42,057 (95% CI, 39,523 to 44,592), $29,961 (95% CI, 21,252 to 38,670), and $26,959 (95% CI, 23,500 to 30,416), respectively (P < 0.001). After adjustment for the effect of other important predictors of cost, such as comorbidity, these differences persisted. Among patients treated with hemodialysis, the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft (P < 0.001). Conclusion: To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Setting

The Conjoint Medical and Research Ethics Board at the University of Calgary (Alberta, Canada) approved the study protocol. In July 1999, a total of 416 patients were treated locally with dialysis (266 patients, in-center hemodialysis; 55 patients, satellite hemodialysis; 79 patients, peritoneal dialysis; 13 patients, home hemodialysis; and 3 patients, self-care hemodialysis). Three hundred thirty-two of these patients had been on dialysis therapy longer than 6 months and were eligible for

Patients

Of 332 patients eligible for the study, 166 patients were enrolled; 88 patients were treated with in-center hemodialysis; 31 patients, satellite hemodialysis; 9 patients, home/self-care hemodialysis; and 38 patients, peritoneal dialysis (32 patients, CAPD; 6 patients, CCPD). One hundred ten patients were not enrolled because of inability to speak English or inability to contact them after repeated attempts, and 56 patients who were contacted did not wish to participate. Nonenrolled patients

Discussion

Direct health care costs for patients with ESRD varied substantially among patients treated with different dialysis modalities. In-center hemodialysis was the most expensive renal replacement therapy, costing more than $50,000/patient-year. Self-care dialysis (ie, home/self-care hemodialysis and peritoneal dialysis) costs an average $20,000 less compared with in-center hemodialysis, in large part because of a lower requirement for nursing care for outpatient dialysis.

Our results, based on

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    *

    Work performed at Foothills Medical Centre, Calgary, Alberta, Canada.

    **

    Supported in part by The Alberta Heritage Foundation for Medical Research and The Center for Advancement of Health, Calgary Regional Health Authority, Calgary, Alberta, Canada.

    Address reprint requests to Braden Manns, MD, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada, T2N 2T9. E-mail: [email protected]

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