Understanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffs.
Nephrol Dial Transplant
; 30(10): 1726-34, 2015 Oct.
Article
em En
| MEDLINE
| ID: mdl-26071229
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Custos de Cuidados de Saúde
/
Terapia de Substituição Renal
/
Hospitalização
/
Falência Renal Crônica
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Nephrol Dial Transplant
Assunto da revista:
NEFROLOGIA
/
TRANSPLANTE
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Reino Unido