Reimbursement and economic factors influencing dialysis modality choice around the world

Abstract

The worldwide incidence of kidney failure is on the rise and treatment is costly; thus, the global burden of illness is growing. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of dialysis. Alternative dialysis modalities are haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. In general, where there is little or no facility or physician reimbursement or payment for PD, the share of PD is very low. Regarding resource availability, when centre HD capacity is high, there is an incentive to use that capacity rather than place patients on home dialysis. In certain countries, there is interest in revising the reimbursement structure to favour home-based therapies, including PD and home HD. Modality selection is influenced by employment status, with an association between being employed and PD as the modality choice. Cost drivers differ for PD and HD. PD is driven mainly by variable costs such as solutions and tubing, while HD is driven mainly by fixed costs of facility space and staff. Many cost comparisons of dialysis modalities have been conducted. A key factor to consider in reviewing cost comparisons is the perspective of the analysis because different costs are relevant for different perspectives. In developed countries, HD is generally more expensive than PD to the payer. Additional research is needed in the developing world before conclusive statements may be made regarding the relative costs of HD and PD.

Perspectives of Patients, Families, and Health Care Professionals on Decision-Making about Dialysis Modality—the Good, the Bad, and the Misunderstandings!

“…It is likely that the system in Singapore-in which most medical services, including pre-dialysis education, are mostly feefor-service, with only limited financial support from the government-may be hindering well-informed decisions. As shown in other settings, implementation of reimbursement is likely to improve patient knowledge of dialysis, thus helping to achieve an informed patient decision for a dialysis modality, which is linked to improved rates of PD uptake (14,47,49,50,53). However, more work is needed to document pre-dialysis education utilization rates in relation to PD uptake and penetration rates.…”

The Effect of Depression and Perceived Social Support Systems on Quality of Life in Dialysis Patients

“…Kidney failure is increasing worldwide (1,2). It has been stated that end-stage renal imposes physical and psychosocial stressors on patients with kidney disease (3).…”

Impact of Global Economic Disparities on Practices and Outcomes of Chronic Peritoneal Dialysis in Children: Insights from the International Pediatric Peritoneal Dialysis Network Registry

“…Currently, almost 60% of PD patients worldwide live in developing countries. Peritoneal dialysis obviously has certain advantages over HD in lower-income countries because of the simplicity of its application and its suitability for home use in remote and rural regions (5). The cost advantage of PD in developed countries is neutralized by lower HD staff costs in the developing world, but local production and facilitated importation of PD consumables may soon boost the further adoption of PD in emerging economies.…”