Análisis de costes y perfil sociocultural del enfermo renal. Impacto de la modalidad de tratamiento / Cost analysis and sociocultural profile of kidney patients. Impact of the treatment method

Antecedentes: El análisis del coste de la enfermedad renal crónica basado en datos individuales, por componentes y modalidades terapéuticas no ha sido publicado en España. Objetivos: a) Estudiar los costes sanitarios de un año de tratamiento con hemodiálisis (HD), trasplante renal (TxR) de cadáver y reno-páncreas (TxRP), y de la enfermedad renal crónica avanzada (ERCA) E4 y E5. b) Evaluar la eventual relación entre disparidad sociocultural, costes y modalidad de tratamiento. Métodos: Estudio observacional de: 1) 81 pacientes con ERCA (53 E4 y 28 E5); 2) 162 con más de 3 meses en HD y 3) 173 con más de 6 meses Tx (140 TxR y 33 TxRP). Los costes se evaluaron en cinco categorías: 1) sesiones de HD, 2) consumo farmacéutico, 3) hospitalizaciones, 4) atención ambulatoria y 5) transporte. Se realizó una encuesta de parámetros sociodemográficos. Resultados: El impacto económico de la HD fue de 47 714 ± 18 360 euros (media ± DS), el del Tx de 13 988 ± 9970 euros, y el de la ERCA 9654 ± 9412 euros. El coste de la HD fue el más elevado en todas las partidas económicas. Los costes fueron similares entre TxR y TxRP. En ERCA, a mayor deterioro renal, mayor coste (E4 7846 ± 8901 frente a E5 13 300 ± 9820, p < 0,01). Los pacientes Tx tenían mejor estatus sociocultural, mientras que los de HD presentaban el peor perfil. No encontramos diferencias en los costes entre los tres grupos socioculturales. Conclusiones: La HD conlleva el mayor impacto económico en todas las partidas, incrementando cinco veces el coste del paciente ERCA y tres veces el del Tx. Optimizar la prevención precoz y el Tx, llegado el caso, deben ser estrategias prioritarias. Este análisis invita a reflexionar acerca de si el estatus sociocultural puede influir en ventajas de oportunidades para el Tx (AU)

Background: The cost analysis of chronic kidney disease based on individual data for treatment methods and components has not been published in Spain. Objectives: a) To study the health costs of a year of treatment with haemodialysis (HD), deceased donor renal transplantation (RTx), renal-pancreas transplantation (RPTx), and S4 and S5 advanced chronic kidney disease (ACKD) b) Assess the potential relationship between sociocultural diversity, costs and treatment method. Methods: Observational study of: 1) 81 patients with ACKD (53 S4 and 28 S5) 2) 162 with more than 3 months on HD and 3) 173 with a Tx for more than 6 months (140 RTx and 33 RPTx). The costs were assessed in five categories: 1) HD sessions, 2) drug intake, 3) hospitalisation, 4) outpatient care and 5) transportation. We carried out a survey with socio-demographic parameters. Results: The financial impact of HD was euros 47,714 ± 18,360 (mean ± SD), that of Tx euros 13,988 ± 9970, and that of ACKD euros 9654 ± 9412. The cost of HD was the highest in all financial items. The costs were similar between RTx and RPTx. In ACKD, the greater the renal deterioration, the greater the cost is (S4 euros 7846 ± 8901 versus S5 euros 13,300 ± 9820, P<.01). Tx patients had the best sociocultural status, while HD patients had the worst profile. We did not find differences in costs between the three sociocultural groups. Conclusions: HD has the greatest financial impact in all items, five times higher than the ACKD patient cost and three times than the Tx patient cost. Optimising early prevention and Tx, if appropriate, must be priority strategies. This analysis invites us to think about whether sociocultural status can have an influence on opportunities for Tx (AU)

Cost analysis and sociocultural profile of kidney patients. Impact of the treatment method.

BACKGROUND: The cost analysis of chronic kidney disease based on individual data for treatment methods and components has not been published in Spain. OBJECTIVES: a) To study the health costs of a year of treatment with haemodialysis (HD), deceased donor renal transplantation (RTx), renal-pancreas transplantation (RPTx), and S4 and S5 advanced chronic kidney disease (ACKD) b) Assess the potential relationship between sociocultural diversity, costs and treatment method. METHODS: Observational study of: 1) 81 patients with ACKD (53 S4 and 28 S5) 2) 162 with more than 3 months on HD and 3) 173 with a Tx for more than 6 months (140 RTx and 33 RPTx). The costs were assessed in five categories: 1) HD sessions, 2) drug intake, 3) hospitalisation, 4) outpatient care and 5) transportation. We carried out a survey with socio-demographic parameters. RESULTS: The financial impact of HD was €47,714±18,360 (mean±SD), that of Tx €13,988±9970, and that of ACKD €9654±9412. The cost of HD was the highest in all financial items. The costs were similar between RTx and RPTx. In ACKD, the greater the renal deterioration, the greater the cost is (S4 €7846±8901 versus S5 €13,300±9820, P<.01). Tx patients had the best sociocultural status, while HD patients had the worst profile. We did not find differences in costs between the three sociocultural groups. CONCLUSIONS: HD has the greatest financial impact in all items, five times higher than the ACKD patient cost and three times than the Tx patient cost. Optimising early prevention and Tx, if appropriate, must be priority strategies. This analysis invites us to think about whether sociocultural status can have an influence on opportunities for Tx.