Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 36 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 307-311
The cost of hemodialysis in Iran


Department of Nephrology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

Click here for correspondence address and email
 

   Abstract 

The use of dialysis in patients with end-stage renal disease (ESRD) remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected using interview and questionnaire. Analyzed costs included: transportation plus absence from work, treatment instruments, drugs and other medical procedures, diet, staff salary, equipment and building support services, non-medical supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with mean age of 47 ± 12 years were studied. The estimated cost of each HD session was about 74 US dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to other developing countries, but significantly less than the cost in developed countries.

Keywords: Cost, End-stage renal disease, Hemodialysis, Iran

How to cite this article:
Arefzadeh A, Lessanpezeshki M, Seifi S. The cost of hemodialysis in Iran. Saudi J Kidney Dis Transpl 2009;20:307-11

How to cite this URL:
Arefzadeh A, Lessanpezeshki M, Seifi S. The cost of hemodialysis in Iran. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2014 Oct 25];20:307-11. Available from: http://www.sjkdt.org/text.asp?2009/20/2/307/45588

   Introduction Top


End-stage renal disease (ESRD) is a serious illness with significant health consequences and high-cost treatment options. [1] As seen worldwide, the prevalence of ESRD has signi­ficantly increased in developing countries. [2] In Iran, the prevalence/incidence of renal replace­ment therapy (RRT) and ESRD have increased from 238 and 49.9 per million population (pmp) in 2000, [3] to 357 and 63.8 pmp, respectively in 2006. [4] Currently, 50% of these patients are on hemodialysis (HD). [4]

The use of dialysis in patients with ESRD remains one of the most resource-intensive and hence, expensive therapeutic interventions. [5],[6],[7] Additionally, the growing number of ESRD patients will devour a greater proportion of health-care budget. Consequently, the world­wide demand for, and cost of renal replace­ment therapy (RRT) is rapidly becoming a major burden for health-care systems. For this reason, chronic kidney disease (CKD) and ESRD are considered as emerging public health problems in developing countries necessitating changes in health-care policies. [8],[9] An accurate estimate of the cost of caring for patients with ESRD and a better understanding of the scope and magnitude of the total economic burden of ESRD would help in making policy decisions and to enable ESRD programs to develop strategies for more cost-efficient care. [10] As there are no studies on estimation of the cost of HD in Iran, this study was performed.


   Materials and Methods Top


Following the approval of the Institutional Review Board, 63 patients with ESRD on chronic HD at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran between April 2006 and June 2007, were recruited into the study. All patients were trea­ted with in-center HD. Patients who survived less than three months after commencement of HD were excluded. The frequency as well as duration of HD was determined by the phy­sician based on available resources and medi­cal necessity.

To assess the overall cost of treating all the patients as well as the unit cost per each dialysis session, we collected cost data associated with dialysis by a customized version of the method utilized by Adomakoh et al. [11] The method was used to determine both direct (those directly attributed to dialysis treatment) and indirect costs (the proportion of overhead costs in­ curred by hospital in providing the dialysis service). Relevant data were collected using interview and questionnaire. Cost analysis was performed from ten different viewpoints as follows:

  1. Transportation cost of patients plus his/her attendant to the dialysis center, the cost of elapsed time, and the expenses related to absence from work.
  2. The cost of treatment instruments (e.g. dialysis supplies like Shaldon catheter, in­jection filters, and non-dialysis supplies like printing material).
  3. The cost of drugs such as erythropoietin, all the solutions and other drugs which were utilized during the dialysis session or were prescribed after that, and other medi­cal procedures (e.g. blood transfusion, laboratory investigations, X-rays, etc.).
  4. Dietary costs.
  5. Costs related to staff salaries (e.g. nursing staff, physicians, and dietitians).
  6. Non-medical supply costs (e.g. office sup­plies, cleaning).
  7. All equipment and building support ser­vices including engineering (fixing and maintenance services), and housekeeping.
  8. Depreciation of installations and equip­ments (e.g. dialysis machines).
  9. Depreciation of reverse osmosis (RO) machine.
  10. Building rental costs.


Data were expressed as mean ± SD for quan­titative variables and percentages for catego­rical variables.


   Results Top


The mean age of the study patients was 47 ± 12 years. Among the 63 patients studied, 47.7% were males and 52.3% were females. All study patients received three sessions of HD weekly with duration per session varying between two and four hours.

The breakdown of HD maintenance costs are shown in [Table 1]. The cost of each session of HD was about US $ 74 through which an annual cost of US $ 11,549 could be estimated for each patient. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the principal contributors to the expenses.


   Discussion Top


The results of this study revealed that the annual cost of dialysis in Iran is higher than that in Mexico, [12] about the same as in Brazil, [13] but lower than the cost in countries such as Canada, [14],[15],[16] Australia's Northern Territory, [17] New Zealand, [18] Greece, [19] United States, [20] Italy, [5],[21] Spain, [22] France, [10],[23] Japan, [24] and Turkey [25] [Table 2].

The differences noted in the reported cost in different studies are very high and cannot be explained only in terms of their annual per capita income. True differences in cost ob­viously ensue as a result of various factors in­ cluding different management protocols, in­patient care, an older population of patients with more co-morbid illnesses (especially in the United States), different local labor costs, import duties and shipping charges, tariffs, etc. [11] For instance, while drugs constituted 53% of overall expenses of dialysis in Greece, [19] we found that they constituted only 11.7% of the cost. The availability of full medical insurance coverage for these patients, makes treatment modalities available for every patient, regard­less of the socioeconomic status. In Iran, all patients with ESRD are eligible for govern­ment-provided medical insurance. The ESRD management program is mainly sponsored by The Ministry of Health (MOH) which acts through the Management Center for Trans­plantation and Special Diseases (MCTSD). [5] Thus, different modalities of RRT are provi­ded at no charge and are accessible to all nationals in Iran. A fixed reimbursement rate is paid for dialysis in both public and private hospitals. [4]

There are several approaches to reduce the annual cost of RRT. Obviously, in the long­term, the most important factor to reduce the overall yearly cost of RRT is to reduce the number of patients with ESRD. This goal can be achieved by preventing the progression of renal disease. [25] In Iran, the most frequent causes of ESRD are diabetes mellitus, hyper­tension, obstructive uropathy, cystic and conge­nital disorders, glomerulonephritis, urinary tract infections, vasculitis, tubulo-interstitial nephritis and pregnancy related. [26] Early detection of these diseases is as important as their optimal treatment and we should place initial focus on strategies and treatments that slow disease progression, to postpone the need for RRT. [4]

Furthermore, considering the fact that HD is the most common RRT modality, accounting for 53.7% of prevalent RRT patients in Iran, [3] it is highly recommended that we try to increase the use of peritoneal dialysis as well as live or cadaveric donor kidney transplantation. [4] Kid­ney transplantation is the most cost-effective treatment for ESRD, [27],[28],[29] and offers considerable savings and a drastic improvement in qua­lity of life in these patients. It has been re­vealed that compared with other countries, the cost of kidney transplantation is low in Iran. [30]

Since transport expenses, which are paid di­rectly by the patients, and work leaves cons­titute the main expenditure section in Iran, as in Spain, [22] we suggest greater use of such modalities as home dialysis or autonomous in­center HD, which are already well developed, and could generate significant savings. [31],[32] In addition, there is room for the use of satellite HD units, a dialysis mode that may prove cost­effective apart from offering psychological benefits to the patients. [19],[21],[32],[33]

Several factors limit interpreting the results of this study. Firstly, we did not consider costs which ESRD imposes on society in terms of production losses due to treatment require­ments, morbidity, mortality, and time spent to care for patients. On the other hand, if com­pensating mechanisms are taken into account, the estimated productivity losses are signifi­cantly lower but still considerable. Additio­nally, differences in funding of health-care systems, in dialysis modality utilization, and other cost estimation techniques limit the accu­racy of comparison of our results with other countries.


   Conclusions Top


In summary, in our single-center study from Iran, we found that the annual cost of dialysis is similar to other developing countries but significantly less than the cost in developed countries. In future studies, further in-depth comparison between the cost of other moda­lities of treatment of ESRD like continuous ambulatory peritoneal dialysis and cadaver/living donor transplantation should be taken into consideration.


   Acknowledgement Top


The authors would like to thank Farzan Ins­titute for Research and Technology for technical assistance.

 
   References Top

1.Zelmer JL. The economic burden of end-stage renal disease in Canada. Kidney Int 2007; 72(9):1122-9.  Back to cited text no. 1    
2.Prodjosudjadi W. Incidence, prevalence, treat­ment and cost of end-stage renal disease in Indonesia. Ethn Dis 2006;16(2 Suppl 2):S2-14-6.  Back to cited text no. 2    
3.Haghighi AN, Broumand B, D'Amico M, Locatelli F, et al. The epidemiology of end­stage renal disease in Iran in an international perspective. Nephrol Dial Transplant. 2002;17 (1):28-32.  Back to cited text no. 3    
4.Mahdavi-Mazdeh M, Zamyadi M, Nafar M. Assessment of management and treatment responses in haemodialysis patients from Tehran province, Iran. Nephrol Dial Transplant 2008;23:288-93  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Tediosi F, Bertolini G, Parazzini F, et al. Cost analysis of dialysis modalities in Italy. Health Serv Manage Res 2001;14(1):9-17.  Back to cited text no. 5    
6.Sennfalt K, Magnusson M, Carlsson P. Com­parison of hemodialysis and peritoneal dialysis­a cost-utility analysis. Perit Dial Int 2002;2 1):39-47.  Back to cited text no. 6    
7.Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term impli­ations. J Am Soc Nephrol 2002;13 Suppl 1: 37-40.  Back to cited text no. 7    
8.Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: Global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant 2005;20(12):2587-93.  Back to cited text no. 8    
9.Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int 2006;70(12):2131-3.  Back to cited text no. 9    
10.Lee H, Manns B, Taub K, et al. Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. Am J Kidney Dis 2002; 40(3):611-22.  Back to cited text no. 10    
11.Adomakoh SA, Adi CN, Fraser HS, Nicholson GD. Dialysis in Barbados: The cost of hemo­ialysis provision at the Queen Elizabeth Hospital. Rev Panam Salud Publica 2004;16 5):350-5.  Back to cited text no. 11    
12.Arredondo A, Rangel R, de Icaza E. Cost­effectiveness of interventions for end-stage renal disease. Rev Saude Publica 1998;32(6): 56-65.  Back to cited text no. 12    
13.Sesso R, Eisenberg JM, Stabile C, et al. Cost­effectiveness analysis of the treatment of end­stage renal disease in Brazil. Int J Technol Assess Health Care 1990;6(1):107-14.  Back to cited text no. 13    
14.Goeree R, Manalich J, Grootendorst P, et al. Cost analysis of dialysis treatments for end­stage renal disease (ESRD). Clin Invest Med 1995;18(6):455-64.  Back to cited text no. 14    
15.Coyte PC, Young LG, Tipper BL, et al. An economic evaluation of hospital-based hemo­ialysis and home-based peritoneal dialysis for pediatric patients. Am J Kidney Dis 1996;27 4):557-65.  Back to cited text no. 15    
16.Prichard SS. The costs of dialysis in Canada. Nephrol Dial Transplant. 1997;12(Suppl 1):22­4.  Back to cited text no. 16    
17.You J, Hoy W, Zhao Y, et al. End-stage renal disease in the Northern Territory: Current and future treatment costs. Med J Aust 2002;176 10):461-5.  Back to cited text no. 17    
18.Croxson BE, Ashton T. A cost effectiveness analysis of the treatment of end stage renal failure. N Z Med J 1990;103(888):171-4.  Back to cited text no. 18    
19.Kaitelidou D, Ziroyanis PN, Maniadakis N, Liaropoulos LL. Economic evaluation of hemodialysis: Implications for technology assessment in Greece. Int J Technol Assess Health Care 2005;21(1):40-6.  Back to cited text no. 19    
20.Garella S. The costs of dialysis in the USA. Nephrol Dial Transplant 1997;12(Suppl 1):10­21.  Back to cited text no. 20  [PUBMED]  
21.Piccoli G, Formica M, Mangiarotti G, et al. The costs of dialysis in Italy. Nephrol Dial Transplant 1997;12(Suppl 1):33-44.  Back to cited text no. 21  [PUBMED]  
22.Rodriguez-Carmona A, Perez Fontan M, Bouza P, et al. The economic cost of dialysis: a comparison between peritoneal dialysis and in­center hemodialysis in a Spanish unit. Adv Perit Dial 1996;12:93-6.  Back to cited text no. 22    
23.Jacobs C. The costs of dialysis treatments for patients with end-stage renal disease in France. Nephrol Dial Transplant 1997;12(Suppl 1):29-32.  Back to cited text no. 23  [PUBMED]  
24.Nakajima I, Akamatsu M, Tojimbara T, et al. Economic study of renal transplantation: A single-center analysis in Japan. Transplant Proc 2001;33(1-2):1891-2.  Back to cited text no. 24    
25.Erek E, Sever MS, Akoglu E, et al. Cost of renal replacement therapy in Turkey. Nephrology (Carlton) 2004;9(1):33-8.  Back to cited text no. 25    
26.Afshar R, Sanavi S, Salimi J. Epidemiology of chronic renal failure in Iran: a four year single­center experience. Saudi J Kidney Dis Transpl 2007;18(2):191-4.  Back to cited text no. 26    
27.Karlberg I, Nyberg G. Cost-effectiveness studies of renal transplantation. Int J Technol Assess Health Care 1995;11(3):611-22.  Back to cited text no. 27    
28.Karlberg I. Cost analysis of alternative treatments in end-stage renal disease. Transplant Proc 1992;24(1):335.  Back to cited text no. 28    
29.Roberts SD, Maxwell DR, Gross TL. Cost­effective care of end-stage renal disease: A billion dollar question. Ann Intern Med 1980;92(2.1):243-8.  Back to cited text no. 29    
30.Nourbala MH, Einollahi B, Kardavani B, et al. The cost of kidney transplantation in Iran. Transplant Proc 2007;39(4):927-9.  Back to cited text no. 30    
31.Benain JP, Faller B, Briat C, et al. Cost of dia­lysis in France. Nephrol Ther 2007;3(3):96-106.  Back to cited text no. 31    
32.Soroka SD, Kiberd BA, Jacobs P. The marginal cost of satellite versus in-center hemodialysis. Hemodial Int 2005;9(2):196­201.  Back to cited text no. 32    
33.Gonzalez-Perez JG, Vale L, Stearns SC, Wordsworth S. Hemodialysis for end-stage renal disease: A cost-effectiveness analysis of treatment-options. Int J Technol Assess Health Care 2005;21(1):32-9.  Back to cited text no. 33    

Top
Correspondence Address:
Alireza Arefzadeh
Department of Nephrology, Imam Khomeini Hospital, Tehran University of Medical Sciences, P.O. Box13185-1678, Tehran
Iran
Login to access the Email id


PMID: 19237828

Get Permissions




 
 
    Tables

  [Table 1], [Table 2]

This article has been cited by
1 Haemodialysis in Jordan: Socio-demographic data, clinical analysis and projecting burden
Shdaifat, E.A. and Manaf, M.R.A.
Middle East Journal of Scientific Research. 2013; 14(5): 624-632
[Pubmed]
2 Long-term survival of patients with end-stage renal disease on maintenance hemodialysis: A Multicenter study in Iran
Beladi-Mousavi, S.S. and Alemzadeh-Ansari, M.J. and Alemzadeh-Ansari, M.H. and Beladi-Mousavi, M.
Iranian Journal of Kidney Diseases. 2012; 6(6): 452-456
[Pubmed]
3 The costs in provision of haemodialysis in a developing country: A multi-centered study
Ranasinghe, P. and Perera, Y.S. and Makarim, M.F.M. and Wijesinghe, A. and Wanigasuriya, K.
BMC Nephrology. 2011; 12(1)
[Pubmed]
4 Costs of hemodialysis and kidney transplantation in Sudan a single center experience
Elsharif, M.E. and Elsharif, E.G. and Gadour, W.H.
Iranian Journal of Kidney Diseases. 2010; 4(4): 282-284
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusions
    Acknowledgement
    References
    Article Tables
 

 Article Access Statistics
    Viewed2604    
    Printed69    
    Emailed0    
    PDF Downloaded461    
    Comments [Add]    
    Cited by others 4    

Recommend this journal