| Abstract|| |
To assess the cost of hemodialysis (HD) delivered at our center according to the treatment protocols based on the current Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines, we analyzed our cost data during the period from 1st of January 2007 to 30th of June 2010. The methods were used to determine both direct costs (related to dialysis treatment such as dialysis disposables, dialysis related drugs, medical personnel, out-patient medications, laboratory and other ancillary services) and overhead costs (building, maintenance and engineering costs, housekeeping, and administrative personnel). During the study period, an average of 2,500 HD sessions per month were performed for 200 patients. The mean total cost per HD session was calculated as 297 US dollars (USD) [1,114 Saudi Riyals (SR)], and the mean total cost of dialysis per patient per year was 46,332 USD (173,784 SR). Direct costs contributed to 81.15% of the total cost from which the personnel cost represented 41.11% and dialysis disposables represented 13.64%, while medications (outpatient and intravenous dialysis related medications including albumin, erythropoiesis stimulating agents, iron and vitamin D3 ) accounted for 12.47% of the total cost. Our total cost level is well below the average cost in the industrialized countries.
|How to cite this article:|
Al Saran K, Sabry A. The cost of hemodialysis in a large hemodialysis center. Saudi J Kidney Dis Transpl 2012;23:78-82
|How to cite this URL:|
Al Saran K, Sabry A. The cost of hemodialysis in a large hemodialysis center. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2019 Nov 19];23:78-82. Available from: http://www.sjkdt.org/text.asp?2012/23/1/78/91306
| Introduction|| |
The advances in medical technology and the improvement in the health services resulted in extension of the human life expectancy with chronic illnesses such as end-stage renal disease (ESRD).  Care of patients with ESRD is essential, but also resource intense.
Currently, the worldwide maintenance dialysis population is exceeding two million and the number is predicted to double within the next decade with increased burden on health care budgets.  Therefore, it is necessary to adopt measures that render the delivery of hemodialysis (HD) more cost effective, ,
Since the cost of dialysis changes over time, a detailed analysis of the current cost of the dialysis services is warranted. Our dialysis center is a freestanding governmental facility, which has an expandable capacity to serve 400-600 patients; all expenses are covered solely by the government.
The aim of this study was to assess the health services cost of HD delivered at our center.
| Patients and Methods|| |
The cost data of all patients dialyzed in our center during the period from 1 st of January 2007 to 30 th of June 2010 were analyzed.
Both the total cost per HD session and the annual cost per patient were calculated. Being a freestanding HD center, the costs of in-patient admissions were not included, except the inpatient admission related to the vascular access.
Methods of dialysis cost calculation
We calculated both the direct dialysis-related costs (dialysis disposables, medical equipments with their maintenance, meals, personnel salaries, intravenous and out-patient medications, vascular access creation and revision, and the cost of laboratory tests and imaging investigations) and the indirect costs (overhead costs incurred by the hospital in the provision of dialysis services).
Activity-based surveys were undertaken through reviews of medical records, unit log books for diagnostic procedures, and pharmacy records. Health care personnel costs were allocated to human resources department and calculated as total salaries (including housing allowances and annual airline tickets) divided by the number of sessions/year (based on the workforce plan followed in our center; one nephrology consultant per 100 patients, one nephrology specialist per 50 patients, one nephrology resident per 25 patients, one nurse per six patients, one pharmacist per 100 patients, three social workers per 100 patients, one renal dietitian per 100 patients, one psychologist and one health educator per 200 patients, as well as one medical secretary per 100 patients).
These figures were based on the recommendation of the national renal workforce planning group 2002  with some modification, considering that our center is a freestanding center and not a hospital-based HD unit, as this necessitates more manpower in certain departments and also for continuous contact with other hospitals in case of patients' referrals for consultation or in-patient admission.
The direct dialysis related cost was calculated according to the current number of dialysis patients (an average of 200 patients during the time of the study), while the indirect cost was calculated based on the current capacity of our center (400 patients).
| Results|| |
During the study period, an average of 2,500 HD sessions per month were performed for an average number of 200 patients. The characteristic criteria of the study group are shown in [Table 1].
[Table 2] shows the unit cost of the categories associated with HD services at our center. The cost is shown in US Dollar (USD) and Saudi Rial (SR) (1 USD = 3.75 SR). The mean total cost of each maintenance HD session was estimated to be 297 USD (1,114 SR). The mean total annual cost of dialysis per patient was estimated to be 46,332 USD (173,784 SR). The percent contribution of each category to the total cost is demonstrated.
|Table 2: The unit cost of the categories associated with hemodialysis provision at Prince Salman Center for Kidney Diseases.|
Click here to view
[Table 3] shows a comparative analysis of the cost of the HD session according to the included categories. This is important as the accounting process varies among different health institutions.
|Table 3: The cost of the hemodialysis session according to the categories included.|
Click here to view
| Discussion|| |
The use of dialysis to treat patients with ESRD remains one of the most resource-intensive therapeutic interventions. ,,
The cost for renal replacement therapy (RRT) has been described to be enormous. However, national and international population-based cost studies are scarce. 
All countries, even industrialized ones, are facing the problem of diminishing financial resources to deal with the increasing health care costs brought on by this life-saving modality of RRT.,
For example, in the United States, many demonstration projects were developed to improve quality of care with a more cost-effective approach.
The establishment of fixed fees for the nephrologists supervising the dialysis was one of the successful strategies to reduce or stabilize the cost. Currently, the renal community in Europe and Canada is promoting the use of freestanding, home/self-care HD, and peritoneal dialysis (PD). ,,
True differences in the cost of HD provision between different studies obviously ensue as a result of various factors, namely, different management protocols, variable standards of care, the older population of patients with more comorbid illness (especially in the United States), different local labor costs, import duties and shipping charges, differences in the methodologies used, dates of the studies, the differences in countries in which the analyses were carried out, and finally the number of dialysis sessions as well as the nurse/patient and physician/patient ratios. Direct comparisons may not be particularly informative.
Furthermore, the comparison between countries in the cost of dialysis must take into consideration the perceived quality of life, as well as morbidity and mortality outcomes in these patients. ,
According to our study, the mean total cost of each maintenance HD session was estimated to be 297 USD (1,114 SR).
The mean total annual cost of dialysis per patient was estimated to be 46,332 USD (173,784 SR). These numbers are well below the average cost in the industrialized countries, ,, although a high standard of care is maintained.
Direct cost is easier to account for than the indirect cost; accounting methods are likely to vary between hospitals and even in one hospital from one year to another, and this adds to the difficulties of comparisons of costs. ,
In conclusion, our study revealed that our total cost level of HD is well below the average cost in the industrialized countries although a high standard of care is maintained. The largest part of costs was due to medical personnel.
| Acknowledgment|| |
Authors are grateful to Engineer Fahad Alderh for his contribution in cost calculation.
| References|| |
|1.||Lazarus JM, Denker BM, Owen WF. Haemodialysis. In: Brenner BM, ed. The Kidney. Philadelphia: WB Saunders; 1996;2424-506. |
|2.||Klarenbach SW. Economic evaluation in renal disease. J Nephrol 2007;20:251-9. |
|3.||Evans RW, Blagg CR, Bryan FA. Implications for health care policy. A social and demographic profile of hemodialysis patients in the United States. JAMA 1981;245(5):487-91. |
|4.||Tediosi F, Bertolini G, Parazzini F, Mecca G, Garattini L. Cost analysis of dialysis modalities in Italy. Health Serv Manage Res 2001;14(1):9- 17. |
|5.||http://www.britishrenal.org/getattachment/Work forcePlanning/WFP_Renal_Book1.pdf.aspx |
|6.||Tediosi F, Bertolini G, Parazzini F, Mecca G, Garattini L. Cost analysis of dialysis modalities in Italy. Health Serv Manage Res 2001;14(1):9- 17. |
|7.||Sennfalt K, Magnusson M, Calsson P. Comparison of hemodialysis and peritoneal dialysis: a cost-utility analysis. Perit Dial Int 2002;22(1): 39-47. |
|8.||Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term implications. J Am Soc Nephrol 2002;13(suppl 1): S37-40. |
|9.||Icks A, Haastret B, Gandjour A, et al. Cost of dialysis: a regional population based analysis. Nephrol Dial Transplant 2010;25:1647-52. |
|10.||Roma˜o JE Jr. End-stage renal failure and national resources: The Brazilian experience. Ren Fail 2006;28:627-9. |
|11.||Straube BM. Commentary. The imperative for change in the US health care payment and delivery systems are clear. Adv Chronic Kidney Dis 2008;15:7-9. |
|12.||Salonen T, Reina T, Oksa H, Sintonen H, Pasternack A. Cost analysis of renal replacement therapies in Finland. Am J Kidney Dis 2003;42:1228-38. |
|13.||Roderick P, Nicholson T, Armitage A, et al. An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales. Health Technol Assess 2005;9:1-178. |
|14.||De Vecchi AF, Dratwa M, Wiedemann ME. Healthcare systems and end-stage renal disease (ESRD) therapies an international review: Costs and reimbursement/funding of ESRD therapies. Nephrol Dial Transplant 1999;14(Suppl 6):31- 41. |
|15.||Benain JP, Faller B, Briat C, et al. Cost of dialysis in France. Nephrol Ther 2007;3:96-106. |
|16.||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;40:611- 22. |
|17.||Hidai H. Need for an incentive-based reimbursement policy toward quality care for dialysis patient management. Kidney Int 2000;58 (1):363-73. |
|18.||McFarlane PA, Mendelssohn DC. A call to arms: economic barriers to optimal dialysis care. Perit Dial Int 2000;20(1):7-12. |
Khalid Al Saran
Prince Salman Center for Kidney Diseases, Riyadh
[Table 1], [Table 2], [Table 3]