Abstract: TH-PO278
Do the Better Medical Results Mean a Higher Costs for the Dialysis Clinic?
Session Information
- Dialysis: Cost, Socioeconomics, Quality of Life
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Marcinkowski, Wojciech, Fresenius, Krakow, Poland
- Zawierucha, Jacek P., Fresenius Medical Care Polska S.A., Poznan, Poland
- Malyszko, Jolanta, Warsaw Medical University, Warsaw, Poland
- Malyszko, Jacek S., Nephrology Department, Bialystok, Poland
Background
The quality of care for hemodialyzed patients is determined by commonly accepted biochemical parameters controlled periodically. In everyday practice evaluation includes, among other things, the dose of dialysis provided, the control of anemia, the control of calcium-phosphate balance, and the patients' nutrition status. Obtaining good results is related to, among other things, the time of dialysis sessions, water consumption, electricity, prescribed pharmacotherapy.
The aim of the study was to retrospectively assess the correlation between the obtained medical results and the costs directly related to the dialysis treatment of patients with chronic renal failure.
Methods
The analysis included 5,500 patients treated in 68 centers in the years 2014-2016. Medical evaluation was based on the percentage of patients achieving the individual target in particular categories: weekly dialysis time > 240 minutes, single-pool kt/v > 1.4, dialysis with arteriovenous fistula, relative overhydration < 13% (female) or <15% (male) , Hb concentration in the range of 10-12 g/dl or > 12 g/dl without the use of erythropoiesis stimulating agents (ESA), albumin > 35 g/l, phosphate concentration < 5.5 mmol/l, patient's protection against new HBV infection and the percentage of patients active on the waiting list for kidney transplantation > 7%. For reaching the clinic target in a single category the center was awarded 1 point. The clinic medical result was the sum of points. The assessment was made on a monthly basis. Monthly treatment costs were also assessed. Costs of dialyzers and dialysis lines, electricity, water, concentrates, ESA, iron, anticoagulation, dialysis fluid concentrates, hygiene and dressing agents were included. The medical results were then correlated with the costs incurred in individual months in subsequent years.
Results
The correlation coefficient r between medical results and costs in 2014, 2015 and 2016 was -0.35 (p <0.005), -0.42 (p <0.001) and -0.51 (p <0.001), respectively.
Conclusion
A statistically significant negative correlation between medical results and costs directly related to the treatment of hemodialyzed patients in three consecutive years suggests that better medical results are obtained in centers that better control medical expenses. Better medical care does not necessarily means higher costs for dialysis centers.