title: Costs and added value of haemodialysis and peritoneal dialysis outsourcing agreements.
abstract: BACKGROUND
  Despite the discrepancy in results from Spanish studies on the costs of dialysis, it is assumed that peritoneal dialysis (PD) is more efficient than haemodialysis (HD).
  
  
  OBJECTIVE
  To analyse the costs and added value of HD and PD outsourcing agreements in Galicia, the medical transport for HD and the relationship between the cost of the agreement and the cost of consumables used in continuous ambulatory peritoneal dialysis (CAPD) with bicarbonate.
  
  
  METHODS
  The cost of the outsourcing agreements and the staff was obtained from official publications. The cost of PD and medical transport were calculated using health service data for one month and extrapolating it to one year. The cost of CAPD consumables was provided by the suppliers. The added value was calculated from the investments generated for each agreement treating 40 patients.
  
  
  RESULTS
  Expressed as patient/year, the mean costs for treatment were €21595 and €25664 in HD and PD, respectively. Medical transport varied between €3323 and €6338, while those of the CAPD agreement and consumables were €19268 and €12057, respectively. The added value was greater with the HD agreement, especially considering the jobs created.
  
  
  CONCLUSIONS
  One cannot generalise that the cost of PD, which is significantly influenced by prescriptions, is lower than that of HD. It would be appropriate to review the additional cost to consumables in the CAPD agreement. The added value generated by dialysis agreements should be considered in future studies and in health planning. More controlled studies are needed to better understand this issue.
authors: Nephrology Department, University Hospital Complex of Vigo, Alto de Puxeiros s/n, Vigo, Pontevedra, Spain. jose.maria.lamas.barreiro@sergas.es
authors: J M
authors: JM
authors: Lamas Barreiro
authors: M
authors: M
authors: Alonso Suárez
authors: J A
authors: JA
authors: Saavedra Alonso
authors: A
authors: A
authors: Gándara Martínez
mesh_terms: D001639:Bicarbonates / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D015314:Dialysis Solutions / Q000191:economics; D004209:Disposable Equipment / Q000191:economics; D005380:Financing, Government / Q000706:statistics & numerical data; D006282:Health Personnel / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D009313:National Health Programs / Q000191:economics; D020416:Outsourced Services / Q000191:economics*; D010530:Peritoneal Dialysis / Q000191:economics* / Q000295:instrumentation; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics; D012051:Reimbursement Mechanisms; D006435:Renal Dialysis / Q000191:economics* / Q000295:instrumentation; D012943:Social Security / Q000191:economics; D013030:Spain; D014187:Transportation of Patients / Q000191:economics
chemical_list: D001639:Bicarbonates; D015314:Dialysis Solutions