Economic Issues of Chronic Kidney Disease and End-Stage Renal Disease.

BACKGROUND: With the growth in the global economy, the number of patients worldwide undergoing renal replacement therapy such as hemodialysis is increasing by 6-7% annually. Accordingly, medical costs for the treatment of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) as well as for renal replacement therapy have become a major issue. SUMMARY: It has been reported that in the United States, the annual medical cost for a patient with CKD is approximately USD 20,000, and that the total medical cost for a CKD patient is higher than that of an ESRD patient [1]. In the present study, we found that the medical costs for renal replacement therapy (RRT) in Japan are reasonable compared to those in the United States and Europe. Key Messages: The medical costs for RRT in Japan are reasonable and are not a major issue in Japan.

Prospects for Vascular Access Education in Developing Countries: Current Situation in Cambodia.

We report our activities training doctors on vascular access procedures at International University (IU) Hospital in Cambodia through a program facilitated by Ubiquitous Blood Purification International, a nonprofit organization that provides medical support to developing countries in the field of dialysis medicine. Six doctors from Japan have been involved in the education of medical personnel at IU, and we have collectively visited Cambodia about 15 times from 2010 to 2016. In these visits, we have performed many operations, including 42 for arteriovenous fistula, 1 arteriovenous graft, and 1 percutaneous transluminal angioplasty. Stable development and management of vascular access is increasingly required in Cambodia due to increased use of dialysis therapy, and training of doctors in this technique is urgently required. However, we have encountered several difficulties that need to be addressed, including (1) the situation of personnel receiving this training, (2) problems with facilities, including medical equipment and drugs, (3) financial limitations, and (4) problems with management of vascular access.

The Economic Issues of Hemodialysis Therapy within the Japanese Health Care System.

BACKGROUND: Expenditure on hemodialysis therapy is high within the Japanese health care system, and cost reductions are desirable to maintain the system. Under these circumstances, both a macroeconomic analysis and a microeconomic analysis of the country's health care system are needed to elucidate its problems. SUMMARY: A macroeconomic analysis showed that Japan's sluggish GDP growth since the 1990s has been a major problem in the allocation of health care resources, and government policies have been put in place to reduce health care expenditure. In contrast, a microeconomic analysis showed that the Japanese health care system is being run very efficiently. For hemodialysis therapy specifically, the mortality rate is low and medical costs are not high, indicating that treatment is being provided in a highly efficient manner. Key Messages: These results suggest the direction that Japan's health care system, including hemodialysis therapy, should take will increase health care expenditure commensurate with the nation's economic growth.

The economic issue of vascular access within the Japanese medical reimbursement system.

We analyzed the current health economics of vascular access (VA) procedures in Japan. Results showed that the yearly VA-related medical expenses were as high as JPY20 billion and accounted for 1.4% of the total healthcare cost for chronic renal failure. The United States Renal Data System (USRDS) statistics showed that in the USA the yearly VA-related medical expenses accounted for 1.2% of the total medical cost for chronic renal failure, indicating that the costs did not differ much between the two countries. Moreover, percutaneous transluminal angioplasty (PTA) accounts for approximately 60% of VA procedures performed in Japan, and this ratio is increasing every year. Due to the aging of society and longer treatment periods, it is thought that PTA will become a significant procedure for the treatment of chronic renal failure in Japan.

The economic issue of on-line hemodiafiltration within the Japanese medical reimbursement system.

One major issue of Japan's health care system is that the Ministry of Health, Labor and Welfare (MHLW) centrally decides on the prices of medical services. Because of this, even if a treatment is deemed superior by the actual medical service provider, it may not be economically feasible to carry out. On-line hemodiafiltration has been reported to be an effective and favorable treatment modality, but the number of treated patients has declined since its approval in 2010 due to its low reimbursement price determined by MHLW. In this way, the problem with the Japanese medical reimbursement system is that MHLW's policy measures can thus affect the details of actual medical practices.