title: The cost of renal dialysis in a UK setting--a multicentre study.
abstract: BACKGROUND
  The UK National Health Service (NHS) will fund renal services using Payment by Results (PbR), from 2009. Central to the success of PbR will be the creation of tariffs that reflect the true cost of medical services. We have therefore estimated the cost of different dialysis modalities in the Cardiff and Vale NHS Trust and six other hospitals in the UK.
  
  
  METHODS
  We used semi-structured interviews with nephrologists, head nurses and business managers to identify the steps involved in delivering the different dialysis modalities. We assigned costs to these using published figures or suppliers' published price lists. The study used mixed costing methods. Dialysis costs were estimated by a combination of microcosting and a top-down approach. Where we did not have access to detailed accounts, we applied values for Cardiff.
  
  
  RESULTS
  The most efficient modalities were automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD), the mean annual costs of which were pound21 655 and pound15 570, respectively. Hospital-based haemodialysis (HD) cost pound35 023 per annum and satellite-unit-based HD cost pound32 669. The cost of home-based HD was pound20 764 per year (based on data from only one unit). The main cost drivers for PD were the costs of solutions and management of anaemia. For HD they were costs of disposables, nursing, the overheads associated with running the unit and management of anaemia.
  
  
  CONCLUSIONS
  Renal tariffs for PbR need to reflect the true cost of dialysis provision if choices about modalities are not to be influenced by erroneous estimates of cost. Knowledge of the true costs of modalities will also maximize the number of established renal failure patients treated by dialysis within the limited funds available from the NHS.
authors.affiliation: Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. BaboolalK@cf.ac.uk
authors.forename: Keshwar
authors.initials: K
authors.lastname: Baboolal
authors.forename: Philip
authors.initials: P
authors.lastname: McEwan
authors.forename: Seema
authors.initials: S
authors.lastname: Sondhi
authors.forename: Piotr
authors.initials: P
authors.lastname: Spiewanowski
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Wechowski
authors.forename: Karen
authors.initials: K
authors.lastname: Wilson
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006436:Hemodialysis Units, Hospital / Q000191:economics; D006437:Hemodialysis, Home / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D015337:Multicenter Studies as Topic; D009313:National Health Programs / Q000191:economics; D006435:Renal Dialysis / Q000191:economics* / Q000706:statistics & numerical data; D006113:United Kingdom