Cost analysis of renal replacement therapy by transplant in a system of bundled payment of dialysis.
Renal replacement therapies (RRT) for patients with end-stage renal failure represent a high burden on European countries' healthcare budget. Our purpose was to report and compare the costs of RRT by hemodialysis (HD) or peritoneal dialysis (PD) and renal transplantation (RT) after introduction of a bundled payment system of dialysis. We analyzed average annual cost of RT in a public national health system hospital - surgical/anesthesiologist team and material, induction and maintenance immunosuppression therapy, hospital stay, diagnostic examinations (DE), and post-transplant office visits (including DE). Incentives paid to hospitals performing RT were included. Annual cost of HD or PD was estimated by bundled payment established in a recently revised law - 537.25 €/wk. Total first year cost or RT is 61 658.14 € and from the second year forth 543.86 €/month. Dialysis costs 28 033.71 €/yr. Break-even point for cost is at 32 months, and from there on, RT is less expensive. Strategies aimed at increasing RT are needed as it confers better survival than RRT by dialysis with lower costs to Portuguese health system.
Nephrology Department, HSA-CHP, Porto, Portugal. mariajoaorocha@hotmail.com
Maria João
MJ
Rocha
Susana
S
Ferreira
La Salete
LS
Martins
Manuela
M
Almeida
Leonídeo
L
Dias
Sofia
S
Pedroso
António Castro
AC
Henriques
Rui
R
Almeida
António
A
Cabrita
D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics*; D010530:Peritoneal Dialysis / Q000191:economics*; D011379:Prognosis; D006435:Renal Dialysis / Q000191:economics*; D017582:Renal Replacement Therapy / Q000191:economics*; D012189:Retrospective Studies