Special articleProspective analysis of global costs for maintenance of patients with ESRD
Section snippets
Methods
The study sample included all patients undergoing dialysis at a 70- to 80-patient inner-city ambulatory outpatient hemodialysis unit affiliated with an academic medical center between March 1, 2000, and March 1, 2001. Two patients who underwent hemodialysis at the ambulatory outpatient unit on a transient basis with repeated transfers to other hemodialysis facilities during the data collection period were excluded from the study. Patients were included in the study until the end of the 12-month
Results
Seventy-six patients were enrolled during the 1-year study period, with 755 patient-months of cost data obtained March 1, 2000, to March 1, 2001. Of the 76 patients, 74 patients received medical care by faculty at the medical center. Two patients were excluded from the hospital cost analysis because they used hospital resources other than ours. Costs for outpatient dialysis for these 2 patients were prorated and included in the total outpatient dialysis costs. There were 11 deaths, and 3
Discussion
The goal of this study is to analyze global costs for the management of an ESRD patient population supported with hemodialysis therapy in an ambulatory outpatient setting. For the present study, we developed a strategy of capturing costs in a prospective format. Medical records were examined carefully and/or patients were interviewed at intervals no longer than 72 hours or the time between visits to the outpatient dialysis unit to document interval utilization of resources. These data then were
Acknowledgements
The authors thank Rachel Herbert, Dawn Aguilar, and Dialysis Clinic, Inc, staff for their excellent assistance.
References (15)
- et al.
Early referral to the nephrologist and timely initiation of renal replacement therapyA paradigm shift in the management of patients with chronic renal failure
Am J Kidney Dis
(1998) - et al.
Economic evaluation and end-stage renal diseaseFrom basics to bedside
Am J Kidney Dis
(2000) - et al.
Morbidity and cost implications of inadequate hemodialysis
Am J Kidney Dis
(2001) - et al.
Influence of co-morbidity on mortality and morbidity in patients treated with hemodialysis
Am J Kidney Dis
(1994) - et al.
A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients
Am J Med
(2000) Prevalence and socio-economic aspects of chronic kidney disease
Nephrol Dial Transplant
(2002)- et al.
Medicare's End-Stage Renal Disease ProgramCurrent status and future prospects
Health Affairs
(1999)
Cited by (34)
Effect of depression on health care utilization in patients with end-stage renal disease treated with hemodialysis
2009, European Journal of Internal MedicineCitation Excerpt :Over the recent decades, dialysis has proven to be a successful life-sustaining therapy, with its effectiveness judged largely by patient survival [2]. The annual cost of ESRD treatment is staggering; Medicare expenditures exceeded $12.36 billion in the United States in 2000 and the same figure in 2002 reached $17 billion, an increase of 11% compared to the cost in 2001 [3]. Hospital hemodialysis itself costs nearly $75,000 per patient per year [4], but health care utilization in the forms of hospital admissions, emergency department visits, and physician visits also contributes to the total cost [4].
Delivery of Multifactorial Interventions by Nurse and Dietitian Teams in a Community Setting to Prevent Diabetic Complications: A Quality-Improvement Report
2008, American Journal of Kidney DiseasesVaccinating adolescents against meningococcal disease in Canada: A cost-effectiveness analysis
2007, VaccineCitation Excerpt :Costs related to sequelae were calculated using annual costs and life expectancy at the age of infection. Direct costs were estimated using several sources [27,29–34]. Sequelae impact on productivity was estimated from data reported by Erickson and colleagues [27,35], as well as other long-term indirect costs related to productivity losses in case of death.
Medication-related problems in ambulatory hemodialysis patients: A pooled analysis
2005, American Journal of Kidney DiseasesImpact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients
2005, Kidney InternationalCitation Excerpt :Finally, when modality switch occurs beyond the first year on peritoneal dialysis, the advantageous expenditure profile of having started on peritoneal dialysis is maintained, albeit attenuated compared to patients who start on peritoneal dialysis and stay on peritoneal dialysis. Previous studies of comparative expenditure on the two modalities had shown an almost consistent pattern of lower annual cost with peritoneal dialysis in the United States and other countries[3,5,6,9,11-16,18,20,21,37-41]. Most of these studies examined overall costs without consideration of the modality switches that are part of the clinical journey of the patient.
Supported in part by the Dialysis Clinic, Inc Paul Teschan Research Grant and Merit Review Research Funds from the Department of Veterans Affairs (F.H. and D.W.P.).