title: Understanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffs.
abstract: BACKGROUND
  In a number of countries, reimbursement to hospitals providing renal dialysis services is set according to a fixed tariff. While the cost of maintenance dialysis and transplant surgery are amenable to a system of fixed tariffs, patients with established renal failure commonly present with comorbid conditions that can lead to variations in the need for hospitalization beyond the provision of renal replacement therapy.
  
  
  METHODS
  Patient-level cost data for incident renal replacement therapy patients in England were obtained as a result of linkage of the Hospital Episodes Statistics dataset to UK Renal Registry data. Regression models were developed to explore variations in hospital costs in relation to treatment modality, number of years on treatment and factors such as age and comorbidities. The final models were then used to predict annual costs for patients with different sets of characteristics.
  
  
  RESULTS
  Excluding the cost of renal replacement therapy itself, inpatient costs generally decreased with number of years on treatment for haemodialysis and transplant patients, whereas costs for patients receiving peritoneal dialysis remained constant. Diabetes was associated with higher mean annual costs for all patients irrespective of treatment modality and hospital setting. Age did not have a consistent effect on costs.
  
  
  CONCLUSIONS
  Combining predicted hospital costs with the fixed costs of renal replacement therapy showed that the total cost differential for a patient continuing on dialysis rather than receiving a transplant is considerable following the first year of renal replacement therapy, thus reinforcing the longer-term economic advantage of transplantation over dialysis for the health service.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Cairns
authors.affiliation: Sheffield Kidney Institute, Sheffield, UK.
authors.forename: James
authors.initials: J
authors.lastname: Fotheringham
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Tomson
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: John L
authors.initials: JL
authors.lastname: Forsythe
authors.affiliation: Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Watson
authors.affiliation: Scottish Renal Registry, Glasgow, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Metcalfe
authors.affiliation: Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast, UK.
authors.forename: Damian G
authors.initials: DG
authors.lastname: Fogarty
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Draper
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Oniscu
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dudley
authors.affiliation: NHS Blood and Transplant, Bristol, UK.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Leydon
authors.affiliation: Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: Rommel
authors.initials: R
authors.lastname: Ravanan
mesh_terms: D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus; D004739:England; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000191:economics*
keywords: comorbidities; established renal failure; hospital costs; regression; renal replacement therapy