UNDERSTANDING THE ECONOMIC BURDEN OF CARE FOR PATIENTS ON RENAL REPLACEMENT THERAPY
The Ontario Renal Network (ORN) aims to increase home dialysis from its current rate (24%) to 40%, based on evidence for its equivalent or superior outcomes and lower costs, versus facility dialysis.
Most published studies report dialysis-specific costs, but not total costs for the complex health needs of dialysis patients. The ORN commissioned this study to understand total health care costs for all dialysis modalities.
All patients in Ontario (Canada’s most populous province) who initiated chronic dialysis at age >18 years from April 2006 to March 2012 were selected from the Canadian Organ Replacement Registry, and grouped by initial modality: facility hemodialysis (HD), home HD, facility short daily or slow nocturnal HD (SD/SN HD), or any peritoneal dialysis (PD).
Using linked administrative healthcare data, we estimated direct medical costs (2012 Canadian dollars) from the payer perspective for inpatient and outpatient hospital visits, including dialysis clinics, laboratory and diagnostic tests, physician services, outpatient prescription drugs, home care including dialysis, and long-term care, for one and five years after dialysis initiation by modality group, adjusted for age, co-morbidity, and sex. Patients were censored at kidney transplant or end of follow-up (March 31, 2013), with a maximum observation time of 7.2 years.
The mean age of the cohort (N=9,302) was 66 years; 60% were male. Most (75.2%) initiated facility HD, 23.5% began PD, <1% initiated home HD or facility SD/SN HD. Home HD patients were youngest (mean age=50 years) with less co-morbidity, compared with other modality groups.
Mean adjusted costs for home HD and PD were similar (one-year = $50,506 and $43,123; five-year = $377,467 and $374,648), and much lower than other modalities. Mean facility HD costs were $102,979, and $515,650 for one and five years, respectively. Mean facility SD/SN HD were highest in the first year ($164,257) and similar to facility HD at five year ($482,453).
Total health care costs for dialysis patients are high, (eg., one-year costs for cancer patients = $26,000). Our one-year costs for total health care are approximately twice as much as the dialysis-specific costs reported in previous studies, indicating the importance of non-dialysis costs. Our findings that home HD and PD are economical alternatives to facility HD provide some evidence for policy initiatives to increase home dialysis.