An Economic Assessment Model of Rural and Remote Satellite Hemodialysis Units.
BACKGROUND
Kidney Failure is epidemic in many remote communities in Canada. In-centre hemodialysis is provided within these settings in satellite hemodialysis units. The key cost drivers of this program have not been fully described. Such information is important in informing the design of programs aimed at optimizing efficiency in providing dialysis and preventative chronic kidney disease care in remote communities.


METHODS
We constructed a cost model based on data derived from 16 of Manitoba, Canada's remote satellite units. We included all costs for operation of the unit, transportation, treatment, and capital costs. All costs were presented in 2013 Canadian dollars.


RESULTS
The annual per-patient cost of providing hemodialysis in the satellite units ranged from $80,372 to $215,918 per patient, per year. The median per patient, per year cost was $99,888 (IQR $89,057-$122,640). Primary cost drivers were capital costs related to construction, human resource expenses, and expenses for return to tertiary care centres for health care. Costs related to transport considerably increased estimates in units that required plane or helicopter transfers.


CONCLUSIONS
Satellite hemodialysis units in remote areas are more expensive on a per-patient basis than hospital hemodialysis and satellite hemodialysis available in urban areas. In some rural, remote locations, better value for money may reside in local surveillance and prevention programs in addition support for home dialysis therapies over construction of new satellite hemodialysis units.
Department of Community Health Sciences, University of Manitoba; Winnipeg, Canada.
Thomas W
TW
Ferguson
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba; Winnipeg, Canada.
James
J
Zacharias
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada.
Simon R
SR
Walker
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada.
David
D
Collister
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada.
Claudio
C
Rigatto
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba; Winnipeg, Canada.
Navdeep
N
Tangri
Department of Medicine, Section of Nephrology, University of Manitoba; Winnipeg, Canada.
Paul
P
Komenda
D006436:Hemodialysis Units, Hospital / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D008350:Manitoba; D018803:Models, Economic; D019114:Remote Consultation; D006435:Renal Dialysis / Q000191:economics*; D040841:Resource Allocation / Q000191:economics*; D019035:Rural Health Services