Epidemiology and outcome research in CKD 5D

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Abstract

Introduction and Aims: The Portuguese National Health Service funds haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system, since 2008. However, this package does not include hospitalizations, physician/emergency room visits, access-related procedures and patient transportation. The aim of our study was to evaluate the annual health care expenses of chronic kidney disease (CKD) patients initiating HD with a catheter (CVC) or an arteriovenous fistula (AVF) and PD, in Portugal.

Methods: The study was performed from the Public Administration perspective. One year cost data of 152 CKD patients who consecutively initiated dialysis in our institution in the year 2008 (HD-AVF, n=65; HD-CVC, n=45; PD, n=42) were generated and analyzed, using an intention-to-treat approach. Annual health care expenses were evaluated using a mixed costing method: a) HD and PD treatment expenses were established as the bundled payment of €547.94 per patient-week; b) hospitalizations (inpatient), physician/emergency room visits (outpatient) and transportation data, related or unrelated to kidney failure as defined by the discharge diagnosis [International Classification of Diseases Ninth Revision codes], was captured from the Information Management Division of São João Hospital. Expenditure was determined in accordance with the Ministry of Health and Welfare Ordinance Legislation; c) dialysis access expenses were estimated using a micro-costing approach, using publicly available hospital suppliers' price lists. Multivariate analysis was used to assess the impact of various comorbid factors on the outcome of interest (annual health care expenses). Results are reported in 2010 Euros (€).