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Understanding cost of care for patients on renal replacement therapy : looking beyond fixed tariffs
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Li, Bernadette, Cairns, John A., Fotheringham, James, Tomson, Charles R., Forsythe, John L., Watson, Christopher, Metcalfe, Wendy, Fogarty, Damian G., Draper, Heather, Oniscu, Gabriel C., Dudley, Christopher, Johnson, Rachel J., Roderick, Paul, Leydon, Geraldine, Bradley, J. Andrew and Ravanan, Rommel (2015) Understanding cost of care for patients on renal replacement therapy : looking beyond fixed tariffs. Nephrology Dialysis Transplantation, 30 (10). pp. 1726-1734. doi:10.1093/ndt/gfv224 ISSN 0931-0509.
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Official URL: http://dx.doi.org/10.1093/ndt/gfv224
Abstract
Background In a number of countries, reimbursement to hospitals providing renal dialysis services is set according to a fixed tariff. While the cost of maintenance dialysis and transplant surgery are amenable to a system of fixed tariffs, patients with established renal failure commonly present with comorbid conditions that can lead to variations in the need for hospitalization beyond the provision of renal replacement therapy.
Methods Patient-level cost data for incident renal replacement therapy patients in England were obtained as a result of linkage of the Hospital Episodes Statistics dataset to UK Renal Registry data. Regression models were developed to explore variations in hospital costs in relation to treatment modality, number of years on treatment and factors such as age and comorbidities. The final models were then used to predict annual costs for patients with different sets of characteristics.
Results Excluding the cost of renal replacement therapy itself, inpatient costs generally decreased with number of years on treatment for haemodialysis and transplant patients, whereas costs for patients receiving peritoneal dialysis remained constant. Diabetes was associated with higher mean annual costs for all patients irrespective of treatment modality and hospital setting. Age did not have a consistent effect on costs.
Conclusions Combining predicted hospital costs with the fixed costs of renal replacement therapy showed that the total cost differential for a patient continuing on dialysis rather than receiving a transplant is considerable following the first year of renal replacement therapy, thus reinforcing the longer-term economic advantage of transplantation over dialysis for the health service.
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Nephrology Dialysis Transplantation | ||||||||
| Publisher: | Oxford University Press | ||||||||
| ISSN: | 0931-0509 | ||||||||
| Official Date: | 2015 | ||||||||
| Dates: |
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| Volume: | 30 | ||||||||
| Number: | 10 | ||||||||
| Page Range: | pp. 1726-1734 | ||||||||
| DOI: | 10.1093/ndt/gfv224 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) |
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