Socioeconomic and Heal Th-Care Policies and Peritoneal Dialysis

Abstract

In 1994, an estimated 631 000 patients were on dialysis. The annual cost of therapy has been variably calculated as US $20 000 -$40 000 per patient per year (1–3). Therefore, dialysis is now a multibillion-dollar international industry. The purpose of this paper is to review the analysis of costs in dialysis, costs differences around the world, and to look at the impact of cost/economic factors on treatment modality selection.

The costs of dialysis can be counted in dollars, pain, inconvenience, or time. In this paper only the dollar costs will be considered. In Canada, which enjoys a comprehensive health-care system, there are four analyses of cost that can be made. These are the costs ascribed to the dialysis unit itself, to the hospital or institution, to the health-care system, and to society at large (Table 1). Costs to the dialysis unit include dialysis supplies, nurses’ salaries, and, usually, drug costs and support staff such as renal dietitians. Institutional costs include the unit costs plus heat, light, maintenance, laboratory tests such as chest x rays, which are costs usually ascribed to the Radiology Department, and hospitalization costs, which are usually applied to a different ward costcenter than the dialysis unit itself. The health-care system costs include the institutional costs plus doctors’ fees, transportation, and community services such as home-care nursing. Social costs are those of the healthcare system plus the costoflost work by the patient and/ or their partner. Unit, institutional, and healthcare costs can be calculated, but the additional costs to society are extremely difficult to measure and, when measurement is attempted, almost certainly inaccurate. To make a reasonable assessment of cost, I believe that, at a minimum, institutional costs must be used, but I prefer an assessment of health-care system costs in a taxpayer-funded system such as Canada.