A Cost Analysis of Haemodialysis and Peritoneal Dialysis for the Management of End-Stage Renal Failure At an Academic Hospital in Pretoria, South Africa

Abstract

BackgroundHaemodialysis (HD) and peritoneal dialysis (PD) are commonly used treatments for the management of patients with end-stage renal disease (ESRD). The costs of managing these patients have grown in recent years with increasing rates of non-communicable diseases, which will adversely impact on national health budgets unless addressed. Currently, there is limited knowledge of the costs of ESRD within the public healthcare system in South Africa.ObjectiveThe aim of this study was to examine the direct costs of HD and PD in South Africa from a healthcare provider’s perspective.MethodsA prospective, observational study was undertaken at a leading public hospital in South Africa. A micro-costing approach was applied to estimate healthcare costs using 46 adult patients with ESRD who had been receiving HD and PD for at least 3 months.ResultsThe highest proportion of patients (35%) were aged 40–50 years. Patients aged 29–39 years were mostly on HD (28% vs. 21% on PD) while those aged 51–59 years mostly used PD (29% vs. 16% on HD). The average age of patients on HD and PD were 41 and 42 years, respectively. Fixed costs were the principal cost driver for HD ($16,231.45) while variable costs were the principal cost driver for PD (US$20,488.79). The annual cost of HD per patient (US$31,993.12) was higher than PD (US$25,282.00 per patient), even though the difference was not statistically significant (p = 0.816).ConclusionHD costs more than PD from the provider’s perspective. These cost estimates may be useful for carrying out future cost-effectiveness and cost-utility analyses in South Africa.

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

“…This includes the need to develop coping strategies and address issues of stigma (88), which are especially crucial if coping strategies involve avoiding injections (88). There is also a need to address concerns with the availability of dialysis services across Africa (92,93).…”

Provision of long-term renal replacement therapy to non-national patients in South Africa

“…Recent analysis estimated the cost per patient per year for haemodialysis to be USD31 993.21, and USD25 282.39 for peritoneal dialysis (ZAR446 153.63 and ZAR352 569.50, respectively, at a ZAR:USD exchange rate of 13.95:1 current at the time of writing). [11] Fixed costs (facility and dialysis machines) contribute significantly to the cost of haemodialysis, while dialysate fluid and other consumables are the chief cost drivers for peritoneal dialysis. [11] Although public-private partnerships (PPPs) have been advocated as a means to reduce these costs and rapidly expand dialysis availability to the state sector, [7] analysis from such a PPP dialysis unit at Pietersburg Hospital reported higher costs for haemodialysis and peritoneal dialysis than those reported by contemporaneous estimations for SA as a whole, in part due to the application of additional outsourcing fees.…”

“…[11] Fixed costs (facility and dialysis machines) contribute significantly to the cost of haemodialysis, while dialysate fluid and other consumables are the chief cost drivers for peritoneal dialysis. [11] Although public-private partnerships (PPPs) have been advocated as a means to reduce these costs and rapidly expand dialysis availability to the state sector, [7] analysis from such a PPP dialysis unit at Pietersburg Hospital reported higher costs for haemodialysis and peritoneal dialysis than those reported by contemporaneous estimations for SA as a whole, in part due to the application of additional outsourcing fees. [12] As a result of the pernicious constraints on availability, access to dialysis has been rationed since the inception of this therapy in SA.…”

Retrospective Study on the Influencing Factors and Prediction of Hospitalization Expenses for Chronic Renal Failure in China Based on Random Forest and LASSO Regression

“…Most of the overall health care costs are related to renal replacement therapy (RRT) (5). Research by Makhele et al (6) showed that in South Africa, from the perspective of healthcare providers, the annual cost of hemodialysis (HD) per patient (31,993.12 US dollars) is higher than that of peritoneal dialysis (PD) (25,282.00 US dollars). The treatment for CRF includes conservative medical treatment and surgical treatment, such as continuous PD, HD, and kidney transplantation.…”