The cost of renal replacement therapy in Brazil and the story of the short blanket

AbstractThe prevalence of end-stage kidney disease (ESKD) is growing worldwide; the survival of these patients requires renal replacement therapy (RRT, a complex and costly treatment). Over 20% of the patients that start RTT had diabetes. Limited evidence on the effect of comorbidities on the cost of RRT exists. This review summarizes the available evidence on the effect of diabetes mellitus (DM) on the cost of RRT. Electronic databases were searched using key words that combined RRT with DM and cost. References were identified with title, abstract, and full-text screening. The studies included were published in English and presented data on the cost of RRT in ESKD patients with comparison between DM status. Seventeen studies were included in this review. The crude and adjusted cost of care estimates for patients on dialysis was generally higher for DM patients. The cost of care of ESKD patients differed according to various treatment modalities and these differences, mainly driven by inpatient costs. Overall, we found an increased cost of RRT care in patients with DM regardless of the type of treatment. Future analysis of the effects of multiple comorbidities should be considered to better understand the effect of DM on the cost of RRT.

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Cost-effectiveness analysis of renal replacement therapy strategies in Guangzhou city, southern China

BMJ Open ◽

10.1136/bmjopen-2020-039653 ◽

2021 ◽

Vol 11 (2) ◽

pp. e039653

Author(s):

Fei Yang ◽

Meixia Liao ◽

Pusheng Wang ◽

Yongguang Liu

Keyword(s):

Cost Effectiveness ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Southern China ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Guangzhou City ◽

Time Horizons ◽

Payer Perspective ◽

The Cost

ObjectivesThis study aims to assess the cost-effectiveness of three renal replacement therapy (RRT) modalities as well as proposed changes of scheduled policies in RRT composition in Guangzhou city.MethodsFrom a payer perspective, we designed Markov model-based cost-effectiveness analyses to compare the cost-effectiveness of three RRT modalities and four different scheduled policies to RRT modalities in Guangzhou over three time horizons (5, 10 and 15 years). The current situation (scenario 1: haemodialysis (HD), 73%; peritoneal dialysis (PD), 14%; kidney transplantation (TX), 13%) was compared with three different scenarios: an increased proportion of incident RRT patients on PD (scenario 2: HD, 47%; PD, 40%; TX, 13%); on TX (scenario 3: HD, 52%; PD, 14%; TX, 34%); on both PD and TX (Scenario 4: HD, 26%; PD, 40%; TX, 34%).ResultsOver 5-year time horizon, HD was dominated by PD. At a willingness-to-pay (WTP) threshold of US$44 300, TX was cost-effective compared with PD with an incremental cost-effectiveness ratio of US$35 518 per quality-adjusted life year (QALY) gained. The scenario 2 held a dominant position over the scenario 1, with a net saving of US$ 5.92 million and an additional gain of 6.24 QALYs. The scenarios 3 and 4 were cost-effective compared with scenario 1 at a WTP threshold of US$44 300. The above results were consistent across the three time horizons.ConclusionsTX is the most cost-effective RRT modality, followed in order by PD and HD. The strategy with an increased proportion of incident patients on PD and TX is cost-effective compared with the current practice pattern at the given WTP threshold. The planning for RRT service delivery should incorporate efforts to increase the utilisation of PD and TX in China.

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MO519THE COST OF CHRONIC KIDNEY DISEASE BEFORE RENAL REPLACEMENT THERAPY IN MOROCCO: A COST OF ILLNESS STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0039 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Amina Chrifi Alaoui ◽

Mohammed Omari ◽

Noura Qarmiche ◽

Omar Kouiri ◽

Basmat Amal Chouhani ◽

...

Keyword(s):

Public Health ◽

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Medical Cost ◽

Social Cost ◽

The Social ◽

Illness Study ◽

The Cost ◽

Cost Of Illness Study

Abstract Background and Aims Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region. Method A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p < 0.05 is the level of statistical significance. Results Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages. Conclusion The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.

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Sustainability of Chronic Kidney Disease Care

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.103 ◽

2021 ◽

Vol 1 (7) ◽

Author(s):

Jonathan Harris ◽

Charlene Argáez

Keyword(s):

Chronic Kidney Disease ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Health System ◽

Replacement Therapy ◽

Conservative Management ◽

Home Dialysis ◽

Home Based ◽

Chronic Kidney Disease Care ◽

The Cost

Strategies to contain the cost of chronic kidney disease (CKD) care and to improve patient outcomes were found across the continuum of care, from prevention and early disease management through later-stage interventions such as conservative management, dialysis, and transplantation. A variety of health system strategies, including funding reform, were identified to help support and enable sustainable CKD care. For those at risk of CKD or in early stages of the disease, public health interventions to support healthy behaviours and ensure access to primary health care seem crucial to preventing or delaying disease progression. For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option. From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.

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Development of the simulation-based German albuminuria screening model (S-GASM) for estimating the cost-effectiveness of albuminuria screening in Germany

PLoS ONE ◽

10.1371/journal.pone.0262227 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262227

Author(s):

Paul Kairys ◽

Thomas Frese ◽

Paul Voigt ◽

Johannes Horn ◽

Matthias Girndt ◽

...

Keyword(s):

Cost Effectiveness ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Age Distribution ◽

Lifetime Prevalence ◽

German Population ◽

Screening Model ◽

Published Evidence ◽

Simulation Based ◽

The Cost

Background Chronic kidney disease is often asymptomatic in its early stages but constitutes a severe burden for patients and causes major healthcare systems costs worldwide. While models for assessing the cost-effectiveness of screening were proposed in the past, they often presented only a limited view. This study aimed to develop a simulation-based German Albuminuria Screening Model (S-GASM) and present some initial applications. Methods The model consists of an individual-based simulation of disease progression, considering age, gender, body mass index, systolic blood pressure, diabetes, albuminuria, glomerular filtration rate, and quality of life, furthermore, costs of testing, therapy, and renal replacement therapy with parameters based on published evidence. Selected screening scenarios were compared in a cost-effectiveness analysis. Results Compared to no testing, a simulation of 10 million individuals with a current age distribution of the adult German population and a follow-up until death or the age of 90 shows that a testing of all individuals with diabetes every two years leads to a reduction of the lifetime prevalence of renal replacement therapy from 2.5% to 2.3%. The undiscounted costs of this intervention would be 1164.10 € / QALY (quality-adjusted life year). Considering saved costs for renal replacement therapy, the overall undiscounted costs would be—12581.95 € / QALY. Testing all individuals with diabetes or hypertension and screening the general population reduced the lifetime prevalence even further (to 2.2% and 1.8%, respectively). Both scenarios were cost-saving (undiscounted, - 7127.10 €/QALY and—5439.23 €/QALY). Conclusions The S-GASM can be used for the comparison of various albuminuria testing strategies. The exemplary analysis demonstrates cost savings through albuminuria testing for individuals with diabetes, diabetes or hypertension, and for population-wide screening.

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Economic evaluation of continuous renal replacement therapy in acute renal failure

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309990134 ◽

2009 ◽

Vol 25 (03) ◽

pp. 331-338 ◽

Cited By ~ 27

Author(s):

Scott Klarenbach ◽

Braden Manns ◽

Neesh Pannu ◽

Fiona M. Clement ◽

Natasha Wiebe ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Cost Effectiveness ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Effectiveness ◽

The Cost

Objectives:Controversy exists regarding the optimal method of providing dialysis in critically ill patients with acute renal failure. We sought to determine the cost-effectiveness of treatment strategies.Methods:Adult subjects requiring renal replacement therapy in a critical care setting who are candidates for intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) were considered within a Markov model. Alternative strategies including IHD, and standard or high dose CRRT were compared. The model considered relevant clinical and economic outcomes, and incorporated data on clinical effectiveness from a recent systematic review and high quality micro-costing data.Results:In the base-case analysis, CRRT was associated with similar health outcomes but higher costs by ($3,679 more than IHD per patient). In scenarios considering alternate cost sources, and higher intensity of IHD (including daily and longer duration IHD), CRRT remained more costly. Sensitivity analysis indicated that even small differences in the risk of mortality or need for long-term chronic dialysis therapy among surviving patients benefits led to dramatic changes in the cost-effectiveness of the modalities considered.Conclusions:Given the higher costs of providing CRRT and absence of demonstrated benefit, IHD is the preferred modality in critically ill patients who are candidates for either IHD or CRRT, although this conclusion should be revisited if future clinical trials establish differences in clinical effectiveness between modalities. Future interventions that are proven to improve renal recovery after acute renal failure are likely to be cost-effective, even if very resource intensive.

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