title: A societal cost-of-illness study of hemodialysis in Lebanon.
abstract: OBJECTIVE
  Renal failure is a growing public health problem, and is mainly treated by hemodialysis. This study aims to estimate the societal costs of hemodialysis in Lebanon.
  
  
  METHODS
  This was a quantitative, cross-sectional cost-of-illness study conducted alongside the Nutrition Education for Management of Osteodystrophy trial. Costs were assessed with a prevalence-based, bottom-up approach, for the period of June-December 2011. The data of 114 patients recruited from six hospital-based units were collected through a questionnaire measuring healthcare costs, costs to patients and family, and costs in other sectors. Recall data were used for the base-case analysis. Sensitivity analyses employing various sources of resources use and costs were performed. Costs were uprated to 2015US$. Multiple linear regression was conducted to explore the predictors of societal costs.
  
  
  RESULTS
  The mean 6-month societal costs were estimated at $9,258.39. The larger part was attributable to healthcare costs (91.7%), while costs to patient and family and costs in other sectors poorly contributed to the total costs (4.2% and 4.1%, respectively). In general, results were robust to sensitivity analyses. Using the maximum value for hospitalization resulted in the biggest difference (+15.5% of the base-case result). Female gender, being widowed/divorced, having hypertension comorbidity, and higher weekly time on dialysis were significantly associated with greater societal costs.
  
  
  CONCLUSIONS
  Information regarding resource consumption and cost were not readily available. Rather, they were obtained from a variety of sources, with each having its own strengths and limitations.
  
  
  CONCLUSIONS
  Hemodialysis represents a high societal burden in Lebanon. Using extrapolation, its total annual cost for the Lebanese society is estimated at $61,105,374 and the mean total annual cost ($18,516.7) is 43.70% higher than the gross domestic product per capita forecast for 2015. Measures to reduce the economic burden of hemodialysis should be taken, by promoting chronic kidney disease's prevention and encouraging transplantation.
authors.affiliation: a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.
authors.forename: Rana
authors.initials: R
authors.lastname: Rizk
authors.affiliation: a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: b Department of Natural Sciences in Public Health, College of Sustainability Sciences and Humanities , Zayed University , Dubai , United Arab Emirates.
authors.forename: Mirey
authors.initials: M
authors.lastname: Karavetian
authors.affiliation: c Faculty of Pharmacy , Lebanese University , Hadath , Lebanon.
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.affiliation: a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
mesh_terms: D000368:Aged; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000628:therapy
keywords: Cost of illness; Costs and cost analysis; Hemodialysis; Lebanon