title: The social cost of chronic kidney disease in Italy.
abstract: This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expenses of low-protein special foods, travel, and formal and informal care. Patients' and caregivers' losses of productivity have been estimated as indirect costs using the human capital approach. Costs have been expressed in Euros (2016). Totals of 279 patients in stage 4 and 205 patients in stage 5 have been enrolled. The estimated mean annual social cost of a patient with CKD were €7422 (±€6255) for stage 4 and €8971 (±€6503) for stage 5 (p < 0.05). Direct medical costs were higher in stage 5 as compared to stage 4; direct non-medical costs and indirect costs accounted, respectively, for 41 and 5 % of the total social cost of CKD stage 4 and for 33 and 9 % of CKD stage 5. In Italy, the overall annual social cost of CKD was €1,809,552,398 representing 0.11 % of the Gross Domestic Product. Direct non-medical costs and indirect costs were weighted on the social cost of CKD almost as much as the direct medical cost. Patients, their families and the productivity system sustain the burden of the disease almost as much as the healthcare system.
authors.affiliation: Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, 56127, Pisa, Italy. g.turchetti@sssup.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Turchetti
authors.affiliation: Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, 56127, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bellelli
authors.affiliation: Nephrology Unit, Azienda USL Toscana centro (ex-AUSL 4), piazza Ospedale 5, 59100, Prato, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Amato
authors.affiliation: Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 6), viale Alfieri 36, 57124, Livorno, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Nephrology Unit, Azienda USL Toscana sud est (ex-AUSL 9), via Cimabue 109, 58100, Grosseto, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Conti
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 12), via Aurelia 335, Lido di Camaiore, Lucca, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Panichi
authors.affiliation: Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 2), via per S.Alessio, Monte San Quirico, Lucca, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rosati
authors.affiliation: Nephrology Unit, Azienda USL Toscana centro (ex-AUSL 10, Santa Maria Annunziata Hospital), piazza Santa Maria Nuova 1, 50122, Firenze, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pizzarelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004526:Efficiency; D004651:Employment / Q000191:economics; D005260:Female; D005502:Food / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000191:economics*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014195:Travel / Q000191:economics
keywords: CKD stages 4 and 5; Chronic kidney disease; Cost of illness; Direct costs; Indirect costs; Italy