title: Employment status and indirect costs in patients with renal failure: differences between different modalities of renal replacement therapy.
abstract: BACKGROUND
  There are evidences of a different employment status between patients undergoing different modalities of renal replacement therapy (RRT).
  
  
  OBJECTIVE
  The present study aims to compare the indirect costs associated to morbidity in the following RRT alternatives: hemodialysis in a specialized center (HD), automated peritoneal dialysis (APD), continuous ambulatory dialysis (CAPD), and renal transplant (TX).
  
  
  METHODS
  An analysis on indirect costs was implemented following the Human Capital Theory. In total, 243 patients in working age were included (32 CAPD, 46 APD, 83 HD and 82 TX) from 8 hospitals. The potentially productive years of life lost (PPYL), the costs of lost labor productivity (LLPc) for the year 2009 and the total cost of PPYL (PPYLtc) until age of retirement were estimated. All the estimations were adjusted by age, sex rates. Non-parametric analysis (a bootstrap confidence intervals of differences in costs calculated following the simple bias-corrected percentile method -1,000 estimates-) was computed to highlight differences in costs.
  
  
  RESULTS
  No significant differences were found in age or sex between groups. LLPc-2009- in HD (6,547€-95% CI: 5,727€-7,366€) was significantly higher (p<.001) than TX (5,079€-95% CI: 4,127€-6,030€) or APD (4,359€-95% CI: 3,064€-5,655€) but not CAPD (5,785€-95% CI: 4,302€-7,269€). PPYLs were: HD 12.58 years-95% CI: 10.42-14.73; TX 10.05-95% CI: 7.45-12.65; APD 6.09-95% CI: 3.43-8.74; CAPD 10.69-95% CI: 6.14-15.23. PPYLtc was higher in HD than in TX, APD or CAPD in all the provided scenarios.
  
  
  CONCLUSIONS
  TX and, specially, APD are the modalities of RRT with the lowest impact on indirect costs due to morbidity showing higher rates of employment than HD and requiring less disability benefits.
authors.affiliation: Gerencia, Fundación Renal ALCER España, Madrid, Spain. jcjulian@alcer.org
authors.forename: Juan C
authors.initials: JC
authors.lastname: Julián-Mauro
authors.forename: Jesús
authors.initials: J
authors.lastname: Cuervo
authors.forename: Pablo
authors.initials: P
authors.lastname: Rebollo
authors.forename: Daniel
authors.initials: D
authors.lastname: Callejo
mesh_terms: D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000191:economics* / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000191:economics* / Q000379:methods