Abstract: SA-PO669

The Cost of Dialysis in Canada: A Contemporary Cost Minimization Analysis

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Ferguson, Thomas W., Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Dumanski, Sandi M., None, Winnipeg, Manitoba, Canada
  • Beaudry, Alain, University of Manitoba, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, None, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, None, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
Background

Over 5,000 patients experience renal failure in Canada every year. Most of these patients will be unable to secure a transplant and will require life-saving hemodialysis or peritoneal dialysis. These therapies are expensive and require a substantial investment from the Canadian public health care system, with over 1.8 billion dollars spent annually. In this study, we aimed to describe the costs of dialysis modalities, including facility hemodialysis, home peritoneal dialysis (PD), and home hemodialysis (HHD) (both for conventional home hemodialysis and with the NxStage System One).

Methods

We determined costs from the perspective of the Canadian public health payer; namely, human resource expenses, medical and surgical supplies, dialysis-related drugs, equipment, utilities, and capital costs. Cost estimates were sourced from hospital statements of operations, product suppliers, established utility rates, and activity-based dialysis workload estimates. Human resource time estimates are based on a review of literature, yielding mean direct and indirect resource consumption.

Results

The model outputs provide accurate estimates of expenditures for dialysis delivery over time. From this, we can generates clear thresholds for life expectancy, below and above which the most cost-effective dialysis modality may be identified. Annual maintenance expense totaled $64,214 for facility dialysis, $38,658 for PD, $39,236 for HHD, and $43,817 for HHD using the NxStage System One. Substantial cost drivers were human resources in facility dialysis (68% of total cost including benefits) compared with 12% for PD and 16 – 18% for home hemodialysis. Medical and surgical supplies accounted for 72% of PD costs compared with 13% for facility dialysis and 40 – 45% for home hemodialysis.

Conclusion

Beyond a model-defined threshold of treatment duration, home-based renal replacement therapy is less expensive than facility-based hemodialysis. When treatment and quality of life outcomes are similar between both treatments, these therapies should be recommended in patients who are capable of self-care. Ease of administering home modality should also be considered in its relation to patient uptake rates. Assisted home dialysis programs should be evaluated in more complex cases.

Funding

  • Commercial Support