title: [Cost of dialysis in France].
abstract: The provision of care for patients with end-stage chronic renal failure is an important medical and economic challenge for the Health Insurance. Previous studies have shown a lower cost for home dialysis. More recently, studies have confirmed identical short-term survival rates between haemodialysis and peritoneal dialysis. Notwithstanding, home dialysis techniques utilization remains weak in France. This work aims at: determining the average annual cost of dialysis, per patient and per technique of dialysis, and assessing the global annual cost of dialysis in France, from the Health Insurance perspective. Methodologically, this article provides a static estimation of the cost of dialysis. Costs related to co-morbidities of end-stage chronic renal failure have not been considered. Standard patient care schemes have been outlined by a multidisciplinary expert committee, for each dialysis technique, and have been valorised using publicly available data and tariffs recorded in 2005. Our result show that home dialysis techniques are the less costly, with an average annual cost per patient of 49.9, 49.7 and 50.0 k euro respectively for home haemodialysis, automated peritoneal dialysis, and continuous ambulatory peritoneal dialysis. Autodialysis, autonomous in-center haemodialysis and in-center haemodialysis respectively cost 59.5, 62.3 and 81.5 k euro per patient and per annum. The total 2005 cost of dialysis for the Health Insurance is estimated at 2.1 billion euro. Therefore, the development of alternative techniques to in-center haemodialysis, such as home dialysis or autonomous in-center haemodialysis, autodialysis being already well developed, could generate savings for the Health Insurance. From the patient's perspective, it could also allow the enlightened choice of the best customized technique, less guided by local offer than by medical or social criteria, as well as by the patient's own opinion.
authors.affiliation: JNB-Développement, 6, rue du Général-Larminat, 75015 Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Benain
authors.forename: Bernadette
authors.initials: B
authors.lastname: Faller
authors.forename: Claude
authors.initials: C
authors.lastname: Briat
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.forename: Michèle
authors.initials: M
authors.lastname: Brami
authors.forename: Martine
authors.initials: M
authors.lastname: Aoustin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dubois
authors.forename: Philippe
authors.initials: P
authors.lastname: Rieu
authors.forename: Cecile
authors.initials: C
authors.lastname: Behaghel
authors.forename: Gérard
authors.initials: G
authors.lastname: Duru
mesh_terms: D017281:Cost of Illness; D005602:France / Q000453:epidemiology; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data