Dialysis Costs Research Articles

Ferric carboxymaltose for iron deficiency in dialysis cost saving

Ferric carboxymaltose for iron deficiency in dialysis cost saving

Healthcare costs of patients on different renal replacement modalities – Analysis of Dutch health insurance claims data

BackgroundThe aim of this study is to present average annual healthcare costs for Dutch renal replacement therapy (RRT) patients for 7 treatment modalities.MethodsHealth insurance claims data from 2012–2014 were used. All patients with a 2014 claim for dialysis or kidney transplantation were selected. The RRT related and RRT unrelated average annual healthcare costs were analysed for 5 dialysis modalities (in-centre haemodialysis (CHD), home haemodialysis (HHD), continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and multiple dialysis modalities in a year (Mix group)) and 2 transplant modalities (kidney from living and deceased donor, respectively).ResultsThe total average annual healthcare costs in 2014 ranged from €77,566 (SD = €27,237) for CAPD patients to €105,833 (SD = €30,239) for patients in the Mix group. For all dialysis modalities, the vast majority (72–84%) of costs was RRT related. Patients on haemodialysis ≥4x/week had significantly higher average annual costs compared to those dialyzing 3x/week (Δ€19,122). Costs for kidney transplant recipients were €85,127 (SD = €39,679) in the year of transplantation and rapidly declined in the first and second year after successful transplantation (resp. €29,612 (SD = €34,099) and €15,018 (SD = €16,186)). Transplantation with a deceased donor kidney resulted in higher costs (€99,450, SD = €36,036)) in the year of transplantation compared to a living donor kidney transplantation (€73,376, SD = €38,666).ConclusionsCAPD patients have the lowest costs compared to other dialysis modalities. Costs in the year of transplantation are 25% lower for patients with kidneys from living vs. deceased donor. After successful transplantation, annual costs decline substantially to a level that is approximately 14–19% of annual dialysis costs.

Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease: A retrospective cohort study.

Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.

An analysis of the direct cost of renal dialysis provided through a public-private partnership at a tertiary hospital in Limpopo Province, South Africa.

Chronic kidney disease (CKD) is increasingly recognised as an important cause of morbidity and mortality in South Africa (SA). Although the cost of dialysis is well documented in developed countries, little is known about this cost in sub-Saharan Africa. To review the costs of providing peritoneal dialysis (PD) and haemodialysis (HD) at the Pietersburg renal dialysis public-private partnership (PPP) unit in Limpopo Province, SA. A retrospective review of the cost of inputs required for HD and PD was conducted from a provider's perspective, covering the period 2007 - 2012. A top-down approach was used to estimate the average annual cost per patient on HD and PD. During the 6-year period under review, the number of patients on dialysis increased from 77 in 2007 to 182 in 2012. More than 60% of the patients were on HD. The average annual cost per patient was estimated to be ZAR212 286 (USD25 888) and ZAR255 076 (USD31106) for HD and PD, respectively, in 2012. Personnel cost, PD supplies, HD supplies, the outsourcing fee and pharmaceutical supplies were the main cost drivers. PD proved to be more expensive than HD, despite the use of locally manufactured fluids. The study highlights the exceptionally high cost of dialysis treatment. Dialysis should be made more accessible by implementing measures to address the main cost drivers. Moreover, a comprehensive approach that includes prevention of CKD at primary healthcare level, an organ donation programme and an effective kidney transplant programme is urgently required in Limpopo. Further research is required to evaluate the cost-effectiveness of the PPP approach.

Economic evaluation of End Stage Renal Disease treatments in Iran

BackgroundEnd-stage Renal Disease is considered a health problem due to the high prevalence and economic burden on society and the health system. This study utilizes a cost-utility analysis to evaluate the costs and outcomes of the Iranian End Stage Renal Disease patients. MethodsA Markov model-based economic evaluation with a societal perspective, and a lifetime horizon performed to quantify the costs and health-related outcomes in terms of QALY. Direct medical costs obtained from hospital billing and medical records and direct non-medical costs, and indirect costs derived from interviews with patients. Three policy options, the hemodialysis, peritoneal dialysis and kidney transplantation were compared. Most of the Transplants from deceased and rest were from Live Related Donors. One-way and probabilistic sensitivity analyses were performed to study uncertainty. ResultsAnnual average cost of hemodialysis is $13477 cost of peritoneal dialysis is $12865, and cost of Transplantation is $16450.The Transplantation arm gained 9.43 QALY compared with peritoneal dialysis and hemodialysis with 6.95 and 6.04 QALY respectively. When Transplantation was compared with peritoneal dialysis, Incremental Cost-Effectiveness Ratio was $1744 per QALY. ICER value suggests that Transplantation is cost-effective compared with peritoneal dialysis at a willingness-to-pay threshold of $12,400, and hemodialysis was dominated. ConclusionThis study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.

Cost of dialysis therapies in rural and remote Australia \u2013 a micro-costing analysis

BackgroundMaintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia’s Northern Territory (NT).MethodsWe undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars.ResultsThere was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies.ConclusionThe cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location.

End-stage renal disease—financial costs and years of life lost in Panama: a cost-analysis study

ObjectivesCentral America is a region with an elevated burden of chronic kidney disease (CKD); however, the cost of treatment for end-stage renal disease (ESRD) remains an understudied area. This study...

Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan

ObjectivesThe total medical (economic) costs of haemodialysis (HD) and peritoneal dialysis (PD), including direct medical costs, out-of-pocket (OOP) costs and productivity losses, have become an important issue. This study aims...

Costs of haemodialysis vs peritoneal dialysis in South Africa

Costs of haemodialysis vs peritoneal dialysis in South Africa

Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

Allowing patients to live for decades without the function of a vital organ is a medical miracle, but one that is not without cost both in terms of morbidity and quality of life and in economic terms. Renal replacement therapy (RRT) consumes between 2% and 5% of the overall health care expenditure in countries where dialysis is available without restrictions. While transplantation is the preferred treatment in patients without contraindications, old age and comorbidity limit its indications, and low organ availability may result in long waiting times. As a consequence, 30–70% of the patients depend on dialysis, which remains the main determinant of the cost of RRT. Costs of dialysis are differently defined, and its reimbursement follows different rules. There are three main ways of establishing dialysis reimbursement. The first involves dividing dialysis into a series of elements and reimbursing each one separately (dialysis itself, medications, drugs, transportation, hospitalisation, etc.). The second, known as the capitation system, consists of merging these elements in a per capita reimbursement, while the third, usually called the bundle system, entails identifying a core of procedures intrinsically linked to treatment (e.g., dialysis sessions, tests, intradialyitc drugs). Each one has advantages and drawbacks, and impacts differently on the organization and delivery of care: payment per session may favour fragmentation and make a global appraisal difficult; a correct capitation system needs a careful correction for comorbidity, and may exacerbate competition between public and private settings, the latter aiming at selecting the least complex cases; a bundle system, in which the main elements linked to the dialysis sessions are considered together, may be a good compromise but risks penalising complex patients, and requires a rapid adaptation to treatment changes. Retarding dialysis is a clinical and economical goal, but the incentives for predialysis care are not established and its development may be unfavourable for the provider. A closer cooperation between policymakers, economists and nephrologists is needed to ensure a high quality of dialysis care.

Optimal timing of hepatitis C treatment among HIV/HCV coinfected ESRD patients: Pre- vs posttransplant.

Patients with end-stage renal disease (ESRD) who are coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) have access to effective treatment options for HCV infection. However, they also have access to HCV-infected kidneys, which historically afford shorter times to transplantation. Given the high waitlist mortality and rapid progression of liver fibrosis among coinfected kidney-only transplant candidates, identification of the optimal treatment strategy is paramount. Two strategies, treatment pre- and posttransplant, were compared using Monte Carlo microsimulation of 1000000 candidates. The microsimulation was stratified by liver fibrosis stage at waitlist addition and wait-time over a lifetime time horizon. Treatment posttransplant was consistently cost-saving as compared to treatment pretransplant due to the high cost of dialysis. Among patients with low fibrosis disease (F0-F1), treatment posttransplant also yielded higher life months (LM) and quality-adjusted life months (QALM), except among F1 candidates with wait times ≥ 18months. For candidates with advanced liver disease (F2-F4), treatment pretransplant afforded more LM and QALM unless wait time was <18months. Moreover, treatment pretransplant was cost-effective for F2 candidates with wait times >71months and F3 candidates with wait times >18months. Thus, optimal timing of HCV treatment differs based on liver disease severity and wait time, favoring pretransplant treatment when cirrhosis development prior to transplant seems likely.

Cost Controversies of a "Home Dialysis First" Policy.

Purpose of review:Kidney Failure is highly prevalent and uses a disproportionate amount of health care funding. In Canada (excluding Quebec), 37 647 people were living with kidney failure in 2016. The single-payer Canadian health care system spends approximately 1.2% of their annual budget on kidney failure. In 2016, 58.4% of patients with kidney failure in Canada (excluding Quebec) were on dialysis as opposed to living with a functioning kidney transplant. Home dialysis modalities including peritoneal dialysis (PD) and home hemodialysis (HD) were used by 18.9% and 4.7% of these patients, respectively. In-center HD and home dialysis (PD and home HD) are often considered equally efficacious and have similar impacts on quality of life. Despite cost minimization analyses suggesting that home dialysis offers cost savings over in-center HD, there has been a slow uptake of home dialysis in developed nations over time, suggesting that controversies and barriers to implementation currently exist. The primary objective of this health policy briefing article is to introduce and address some of the major controversies surrounding the cost effectiveness in supporting advocacy for a “Home Dialysis First” policy with a primary focus on single-payer systems in a developed nation such as Canada.Sources of information:Canadian Agency for Drugs and Technologies in Health (CADTH), Canadian and US epidemiologic databases, national/international conference presentations, primary literature review, and discussion with experts within the field of home dialysis.Methods:We have conducted a focused primary literature review alongside individuals with expertise in the field of home dialysis to discuss the cost controversies surrounding the implementation of a “Home Dialysis First” policy.Key findings:First, the primary literature is limited to mostly observational studies which are highly variable in study design and content. Local economic assessments, however, have provided convincing data for home dialysis cost savings in Canada. Second, the cost of delivering dialysis differs significantly throughout the world, explained by differing costs of labor and supplies in developing nations. Third, the indirect patient costs of water, energy, and home modifications are often barriers to implementation and may be overcome by introducing cost reimbursement programs. Fourth, home dialysis requires upfront training costs. We explore the impact of premature switches from home dialysis to in-center HD or a functioning kidney transplant on overall cost savings. Fifth, we discuss the effect of physician financial incentives and program funding on the uptake of home dialysis. Finally, we introduce the controversial topic of comparing the societal value of freedom of modality choice against the societal cost savings of a “Home Dialysis First” policy.Limitations:Narrative reviews, due to their inherently reduced methodological quality in comparison with systematic reviews, may expose our collected literature to selection bias. We have attempted to compose a diverse collection of available literature alongside consensus expertise to provide a fair and concise review of home dialysis cost controversies.Implications:Implementation of a “Home Dialysis First” policy would be a disruptive change to kidney failure care in Canada. To make informed policy decisions, we should recognize the cost savings associated with home dialysis in developed nations, the significance of patient-borne costs as a barrier to implementation, the impact of training costs and early modality switching in home dialysis, the lack of evidence regarding physician financial incentives, and the importance of program funding. Ultimately, we must consider the societal value of freedom of patient modality choice in comparison with the potential cost savings of a “Home Dialysis First” policy.

A cost comparison of rasburicase versus dialysis in the management of children with acute leukaemia and lymphoma at a South African centre

Background: Tumour lysis syndrome is a common complication of haematological malignancies and has historically been managed with hyperhydration, urine alkalinisation and allopurinol with renal dialysis reserved for patients in acute renal failure. Rasburicase has been shown to drastically reduce the need for dialysis; however, its use is limited in developing countries owing to its cost and availability.Aim: This retrospective analysis aimed to compare the cost to state per patient of rasburicase compared to dialysis in the management and prevention of tumour lysis syndrome in paediatric patients presenting with haematological malignancies admitted to Red Cross War Memorial Children’s Hospital (RCWMCH).Setting: Red Cross War Memorial Children’s Hospital.Methods: Patients from two consecutive 35 month periods, before and after the availability of rasburicase at RCWMCH, were grouped according to treatment modality, and the cumulative costs of hospitalisation, dialysis and drug administration were compared.Results: The groups were comparable in mean age and gender. The mean total length of hospital stay was 10.04 days shorter for the rasburicase group than the dialysis group with the average cost per patient in the rasburicase group being R40 989.64 lower than the dialysis group.Conclusion: The use of rasburicase results in a significant per patient cost saving when compared to dialysis, which often requires intensive care admission, and results in extended hospitalisation. The study supports the continued use of rasburicase as an essential adjunct in the management and prevention of tumour lysis syndrome, reaffirming its use as a cost-effective and efficient drug.

PUK11 - ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE RELATED COMPLICATIONS AND THERAPIES IN CHINA: QUANTIFYING THE COSTS OF CARDIOVASCULAR EVENTS, BLOOD TRANSFUSION FOR ANEMIA AND DIALYSIS

Our objective was to estimate the costs of common chronic kidney disease (CKD)-related complications and therapies (cardiovascular (CV) events, blood transfusion for anemia, and dialysis) in China, for use in health economic analysis. This retrospective observational study used inpatient and outpatient insurance claims data from the China Health Insurance Research Association (CHIRA) in 2015. Adult patients with a CKD diagnosis were included. For patients with a hospitalization for CV events between 01/01/2015 and 30/09/2015, total inpatient costs per hospitalization were calculated, stratified by CV event type and dialysis status. Outpatient costs were determined for the three months post hospital discharge. Mean monthly costs before hospitalization were calculated for a patient subset with hospital admission after 01/04/2015. Furthermore, the cost of red blood cell transfusion (RBCT) during anemia-related hospitalizations was determined. Finally, monthly health care costs, including dialysis costs, were calculated for patients with ≥3 consecutive months with dialysis records. Among 31,886 CKD patients included in 2015, 2,871 patients had a CV hospitalization. The overall mean (median) cost per hospitalization was ¥14,488 (¥7871). Myocardial infarction was the costliest CV event (mean/median inpatient cost ¥29,203/¥13,046). Mean monthly outpatient costs per patient were higher post discharge (1st month: ¥264; 2nd month: ¥251; 3rd month: ¥228) than before the hospitalization (¥188.10; based on patient subset). Among the 1,227 patients with anemia-related hospitalizations with RBCT, the mean/median cost of blood products was ¥1,895/¥960 per patient per hospitalization. The 3,447 dialysis patients in our dataset incurred a mean/median monthly health care cost of ¥10,235/¥8,002 per patient, of which ¥5,874/¥5,240 were dialysis costs. Hemodialysis was more costly than peritoneal dialysis (mean/median monthly costs ¥6,096/¥5,348 vs. ¥3,861/¥3,939, respectively). Using high-quality insurance data from China, we quantified the costs of common CKD-related complications and therapies, which are major contributors to the economic burden of CKD.

The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient.

Intensive care unit (ICU) delirium is highly prevalent and a potentially avoidable hospital complication. The current cost of ICU delirium is unknown. To specify the association between the daily occurrence of delirium in the ICU with costs of ICU care accounting for time-varying illness severity and death. We performed a prospective cohort study within medical and surgical ICUs in a large academic medical center. We analyzed critically ill patients (N=479) with respiratory failure and/or shock. Covariates included baseline factors (age, insurance, cognitive impairment, comorbidities, Acute Physiology and Chronic Health Evaluation II Score) and time-varying factors (sequential organ failure assessment score, mechanical ventilation, and severe sepsis). The primary analysis used a novel 3-stage regression method: first, estimation of the cumulative cost of delirium over 30 ICU days and then costs separated into those attributable to increased resource utilization among survivors and those that were avoided on the account of delirium's association with early mortality in the ICU. The patient-level 30-day cumulative cost of ICU delirium attributable to increased resource utilization was $17,838 (95% confidence interval, $11,132-$23,497). A combination of professional, dialysis, and bed costs accounted for the largest percentage of the incremental costs associated with ICU delirium. The 30-day cumulative incremental costs of ICU delirium that were avoided due to delirium-associated early mortality was $4654 (95% confidence interval, $2056-7869). Delirium is associated with substantial costs after accounting for time-varying illness severity and could be 20% higher (∼$22,500) if not for its association with early ICU mortality.

Cost-effectiveness of hepatitis C-positive donor kidney transplantation for hepatitis C-negative recipients with concomitant direct-acting antiviral therapy.

Pilot studies suggest that transplanting hepatitis C virus (HCV)-positive donor (D+) kidneys into HCV-negative renal transplant (RT) recipients (R-), then treating HCV with direct-acting antivirals (DAA) is clinically feasible. To determine whether this is a cost-effective approach, a decision tree model was developed to analyze costs and effectiveness over a 5-year time frame between 2 choices: RT using a D+/R- strategy compared to continuing dialysis and waiting for a HCV-negative donor (D-/R-). The strategy of accepting a HCV+ organ then treating HCV was slightly more effective and substantially less expensive and resulted in an expected 4.8years of life (YOL) with a cost of ≈$138000 compared to an expected 4.7 YOL with a cost of ≈$329000 for the D-/R- strategy. The D+/R- strategy remained dominant after sensitivity analyses including the difference in RT death probabilities or acute rejection probabilities between using D+ vs D- kidney; time that D-/R- patients waited for RT; dialysis death probabilities while waitlisted for RT in the D-/R- strategy; DAA therapy expected cure rate; costs of transplant, immunosuppressives, DAA therapy, dialysis, or acute rejection. The D+/R- strategy followed by treatment with DAA is less costly and slightly more effective compared to the D-/R- strategy.

Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ?

Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin D sterols to treat SHPT, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet and the recently approved intravenously administered agent, etelcalcetide. While cinacalcet is an allosteric modulator of the CaSR, etelcalcetide acts as a direct CaSR agonist. Etelcalcetide's properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session. Etelcalcetide has recently been shown to be more potent than cinacalcet in reducing PTH levels. However, etelcalcetide appears, like cinacalcet, to cause gastrointestinal intolerance. Additionally, etelcalcetide, which appears to reduce calcium substantially more than cinacalcet does, can prolong the QTc electrocardiographic interval. While etelcalcetide is very effective at reducing PTH levels, the current climate of dialysis cost containment in the United States may limit its widespread use. This review compares and contrasts the pharmacologic characteristics of cinacalcet and etelcalcetide, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice.

Initiating Maintenance Dialysis Before Living Kidney Donor Transplantation When a Donor Candidate Evaluation Is Well Underway.

Preemptive kidney transplants result in better outcomes and patient experiences than transplantation after dialysis onset. It is unknown how often a person initiates maintenance dialysis before living kidney donor transplantation when their donor candidate evaluation is well underway. Using healthcare databases, we retrospectively studied 478 living donor kidney transplants from 2004 to 2014 across 5 transplant centers in Ontario, Canada, where the recipients were not receiving dialysis when their donor's evaluation was well underway. We also explored some factors associated with a higher likelihood of dialysis initiation before transplant. A total of 167 (35%) of 478 persons with kidney failure initiated dialysis in a median of 9.7 months (25th-75th percentile, 5.4-18.7 months) after their donor candidate began their evaluation and received dialysis for a median of 8.8 months (3.6-16.9 months) before kidney transplantation. The total cohort's dialysis cost was CAD $8.1 million, and 44 (26%) of 167 recipients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 months (6.4-21.6 months) for preemptive transplants and 22.4 months (13.1-38.7 months) for donors whose recipients started dialysis before transplant. Recipients were more likely to start dialysis if their donor was female, nonwhite, lived in a lower-income neighborhood, and if the transplant center received the recipient referral later. One third of persons initiated dialysis before receiving their living kidney donor transplant, despite their donor's evaluation being well underway. Future studies should consider whether some of these events can be prevented by addressing inappropriate delays to improve patient outcomes and reduce healthcare costs.

Return on investment for financial assistance for living kidney donors in the United States.

The National Living Donor Assistance Center (NLDAC) enables living donor kidney transplants through financial assistance of living donors, but its return on investment (ROI) through savings on dialysis costs remains unknown. We retrospectively reviewed 2012-2015 data from NLDAC, the United States Renal Data System, and the Scientific Registry of Transplant Recipients to construct 1-, 3-, and 5-year ROI models based on NLDAC applications and national dialysis and transplant cost data. ROI was defined as state-specific federal dialysis cost minus (NLDAC program costs plus state-specific transplant cost), adjusted for median waiting time (WT). A total of 2425 NLDAC applications were approved, and NLDAC costs were USD $6.76 million. Median donor age was 41years, 66.1% were female, and median income was $33759; 43.6% were evaluated at centers with WT >72months. Median dialysis cost/patient-year was $81485 (IQR $74489-$89802). Median kidney transplant cost/patient-year was $30101 (IQR $26832-$33916). Overall, ROI varied from 5.1-fold (1-year) to 28.2-fold (5-year), resulting in $256 million in savings. Higher ROI was significantly associated with high WT, larger dialysis and transplant costs differences, and more NLDAC applicants completing the donation process. Financial support for donor out-of-pocket expenses produces dramatic federal savings through incremental living donor kidney transplants.

Cost drivers for managing dialysis facilities in a large chain in Taiwan

PurposeAs the rise in expenditures will be even faster when the baby-boom generation soon reaches healthcare-dependent ages, healthcare providers are facing cost management decision of achieving superior performance. Taiwan provides a unique environment that the dialysis service providers face only one medical buyer. The purpose of this paper is to discuss cost factors of dialysis facilities.Design/methodology/approachThis study provides a comprehensive analysis of factors influencing the dialysis costs using the data collected from a large renal clinic chain at Taiwan. The multiple linear regression analysis is employed to examine the factors influencing dialysis costs. The research sample composed of 1,255 patients is collected from 16 dialysis centers in Taiwan.FindingsThe results indicate that the treatment costs of dialysis are influenced by managerial factors including capacity utilization rate (CUR), the percentage of shares held by the owners and the geographical location of clinics (LC). The findings assist renal clinics to identify the parts critical to the cost control. Our results indicate that medical variable costs for performing the dialysis treatments are significantly influenced by such managerial factors as CUR, the percentage of owners’ shares holding and LC.Practical implicationsBy identifying a comprehensive set of costs drivers for dialysis services, this study provides useful information for both health providers and policy makers. In specific, the result assists these providers to consider the utilization of better mechanisms/instruments to control costs by increasing the operational efficiency and achieving the economies of scale.Originality/valueThis paper contributes to exploring costs drivers that are generally absent from the extant literature. The result suggests that the regulators should be aware that the dialysis providers may reject costly patients. Hence, to establish the appropriate monitoring mechanisms to prevent such incidence is important. Finally, many other countries in addition to Taiwan also have a similar practice as national health insurances or services (e.g. Medicare in the USA or National Health Service in the UK). Those health systems may all face a similar cost control issues for handling end-stage renal disease patients. The analysis can help health systems worldwide to better design the reimbursement rates to account for the differences existed in dealing with the dialysis treatment costs.