title: The role of economies of scale in the cost of dialysis across the world: a macroeconomic perspective.
abstract: BACKGROUND
  The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries.
  
  
  METHODS
  From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several country level indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country's level of development, economies of scale and percentage of private health-care expenditure.
  
  
  RESULTS
  The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant.
  
  
  CONCLUSIONS
  it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the absence of a large enough market to make local production of PD equipment feasible in that country.
authors: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors: Akash Nayak
authors: AN
authors: Karopadi
authors: Giacomo
authors: G
authors: Mason
authors: Enrico
authors: E
authors: Rettore
authors: Claudio
authors: C
authors: Ronco
mesh_terms: D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D006435:Renal Dialysis / Q000191:economics*; D012959:Socioeconomic Factors
keywords: CKD; economic evaluation; haemodialysis; health policy; peritoneal dialysis