Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis

Abstract

Background Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia’s Northern Territory (NT). Methods We undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars. Results There was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies. Conclusion The cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location. Electronic supplementary material The online version of this article (10.1186/s12882-019-1421-z) contains supplementary material, which is available to authorized users.

Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings

“…Average cost weights are attributed to each episode of care [ 32 ]; and. published data of per dialysis treatment costs (inclusive of infrastructure costs) from a recent micro-costing analysis of dialysis program expenditure in the NT [ 19 ]. …”

“…1 ). The analysis was restricted to 2008 to 2014 to ensure sufficient activity was available across all models (new and developing) and to marry with the micro-costing analysis time frame [ 19 ]. Eight patients (n = 8) were excluded as they did not have any cost data (Fig.…”

“…For instance, while maintenance dialysis as an outpatient is captured for each treatment as a same day admission, the cost differential between different models and regions are not adequately recognised in the case mix funding model. The cost for each same day dialysis at each DxMoC was replaced with the relevant and representative cost from the micro costing study [ 19 ]. Incentre haemodialysis (DxMoC0) is accepted as being more expensive than satellite dialysis (DxMoC1) [ 36 , 37 ].…”

“…Yearly DxMoC6 costs were applied as a proportion of the time spent in the model. The replacement costs for AR-DRG code L61Z (same day haemodialysis) and one-off costs applied for DxMoC6 (peritoneal dialysis) based on the representative values from the micro costing study [ 19 ] are in Table 3 .…”

“…Studies have suggested a relationship between the frequency and cost of hospitalisations and specific treatment modalities [ 13 – 16 ]. A few cost studies have also compared the delivery of dialysis treatments across different locations, noting the increased infrastructure and recurrent costs per patient per year associated with remote based services [ 17 – 19 ].…”