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Comparative Study
. 2018 Aug 7;13(8):1197-1203.
doi: 10.2215/CJN.10180917. Epub 2018 Jul 18.

Cost of Dialysis Therapy by Modality in Manitoba

Alain Beaudry  1   2 , Thomas W Ferguson  1   2 , Claudio Rigatto  1   2 , Navdeep Tangri  1   2 , Sandi Dumanski  3 , Paul Komenda  1   2
Affiliations
Comparative Study

Cost of Dialysis Therapy by Modality in Manitoba

Alain Beaudry et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: The prevalence of ESKD is increasing worldwide. Treating ESKD is disproportionately costly in comparison with its prevalence, mostly due to the direct cost of dialysis therapy. Here, we aim to provide a contemporary cost description of dialysis modalities, including facility-based hemodialysis, peritoneal dialysis, and home hemodialysis, provided with conventional dialysis machines and the NxStage System One.

Design, setting, participants, & measurements: We constructed a cost-minimization model from the perspective of the Canadian single-payer health care system including all costs related to dialysis care. The labor component of costs consisted of a breakdown of activity-based per patient direct labor requirements. Other costs were taken from statements of operations for the kidney program at Seven Oaks General Hospital (Winnipeg, Canada). All costs are reported in Canadian dollars.

Results: Annual maintenance expenses were estimated as $64,214 for in-center facility hemodialysis, $43,816 for home hemodialysis with the NxStage System One, $39,236 for home hemodialysis with conventional dialysis machines, and $38,658 for peritoneal dialysis. Training costs for in-center facility hemodialysis, home hemodialysis with the NxStage System One, home hemodialysis with conventional dialysis machines, and peritoneal dialysis are estimated as $0, $16,143, $24,379, and $7157, respectively. The threshold point to achieve cost neutrality was determined to be 9.7 months from in-center hemodialysis to home hemodialysis with the NxStage System One, 12.6 months from in-center hemodialysis to home hemodialysis with conventional dialysis machines, and 3.2 months from in-center hemodialysis to peritoneal dialysis.

Conclusions: Home modalities have lower maintenance costs, and beyond a short time horizon, they are most cost efficient when considering their incremental training expenses.

Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_07_18_CJASNPodcast_18_8_F.mp3.

Keywords: Cost of Illness; Economic Analysis; Economic Impact; Epidemiology and outcomes; Hospitals, General; Kidney Failure, Chronic; Kidneys, Artificial; Prevalence; chronic dialysis; chronic hemodialysis; clinical epidemiology; dialysis; hemodialysis; peritoneal dialysis; renal dialysis.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Home hemodialysis provided with the NxStage machine results in cost savings versus home hemodialysis provided with a conventional machine if treatment duration is <25.6 months. HD, hemodialysis; PD, peritoneal dialysis.
See this image and copyright information in PMC

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