Costs and added value of haemodialysis and peritoneal dialysis outsourcing agreements.

BACKGROUND: Despite the discrepancy in results from Spanish studies on the costs of dialysis, it is assumed that peritoneal dialysis (PD) is more efficient than haemodialysis (HD). OBJECTIVES: To analyse the costs and added value of HD and PD outsourcing agreements in Galicia, the medical transport for HD and the relationship between the cost of the agreement and the cost of consumables used in continuous ambulatory peritoneal dialysis (CAPD) with bicarbonate. METHODS: The cost of the outsourcing agreements and the staff was obtained from official publications. The cost of PD and medical transport were calculated using health service data for one month and extrapolating it to one year. The cost of CAPD consumables was provided by the suppliers. The added value was calculated from the investments generated for each agreement treating 40 patients. RESULTS: Expressed as patient/year, the mean costs for treatment were €21595 and €25664 in HD and PD, respectively. Medical transport varied between €3323 and €6338, while those of the CAPD agreement and consumables were €19268 and €12057, respectively. The added value was greater with the HD agreement, especially considering the jobs created. CONCLUSIONS: One cannot generalise that the cost of PD, which is significantly influenced by prescriptions, is lower than that of HD. It would be appropriate to review the additional cost to consumables in the CAPD agreement. The added value generated by dialysis agreements should be considered in future studies and in health planning. More controlled studies are needed to better understand this issue.

Costes y valor añadido de los conciertos de hemodiálisis y diálisis peritoneal / Costs and added value of haemodialysis and peritoneal dialysis outsourcing agreements

Antecedentes: A pesar de los resultados discrepantes en estudios españoles sobre costes de diálisis, se asume que la diálisis peritoneal (DP) es más eficiente que la hemodiálisis (HD). Objetivos: Analizar los costes del concierto de HD y DP en Galicia y su valor añadido, los del transporte sanitario para HD y la relación en diálisis peritoneal continua ambulatoria (DPCA) con bicarbonato entre el coste del concierto y el del fungible utilizado. Métodos: El coste de los conciertos y del personal se obtuvo de publicaciones oficiales. Los de DP y del transporte sanitario se calcularon con datos del servicio de salud de un mes, extrapolados a un año. El del fungible de DPCA fue facilitado por proveedores. El valor añadido se estimó con las inversiones generadas por cada concierto tratando 40 pacientes. Resultados: Expresados por paciente/año, los costes medios del tratamiento fueron 21.595 y 25.664 € en HD y DP, respectivamente; los del trasporte sanitario oscilaron entre 3.323 y 6.338 € y los del concierto y fungible de DPCA fueron 19.268 y 12.057 €, respectivamente. El valor añadido fue superior con el concierto de HD, destacando los puestos de trabajo generados. Conclusiones: No puede generalizarse la afirmación de que el coste de DP, muy influenciado por la prescripción, es inferior al de HD. Convendría revisar el coste adicional al fungible en el concierto de DPCA. El valor añadido generado por los conciertos de diálisis debería considerarse en futuros estudios y en la planificación sanitaria. Se necesitan más estudios controlados para conocer mejor esta cuestión (AU)

Background: Despite the discrepancy in results from Spanish studies on the costs of dialysis, it is assumed that peritoneal dialysis (PD) is more efficient than haemodialysis (HD). Objectives: To analyse the costs and added value of HD and PD outsourcing agreements in Galicia, the medical transport for HD and the relationship between the cost of the agreement and the cost of consumables used in continuous ambulatory peritoneal dialysis (CAPD) with bicarbonate. Methods: The cost of the outsourcing agreements and the staff was obtained from official publications. The cost of PD and medical transport were calculated using health service data for one month and extrapolating it to one year. The cost of CAPD consumables was provided by the suppliers. The added value was calculated from the investments generated for each agreement treating 40 patients. Results: Expressed as patient/year, the mean costs for treatment were €21 595 and €25 664 in HD and PD, respectively. Medical transport varied between €3323 and €6338, while those of the CAPD agreement and consumables were €19 268 and €12 057, respectively. The added value was greater with the HD agreement, especially considering the jobs created. Conclusions: One cannot generalise that the cost of PD, which is significantly influenced by prescriptions, is lower than that of HD. It would be appropriate to review the additional cost to consumables in the CAPD agreement. The added value generated by dialysis agreements should be considered in future studies and in health planning. More controlled studies are needed to better understand this issue (AU)