Access to Kidney Transplantation Among Remote- and Rural-Dwelling Patients With Kidney Failure in the United States

Tonelli, Marcello; Klarenbach, Scott; Rose, Caren; Wiebe, Natasha; Gill, John S.

doi:10.1001/jama.2009.545

Cited by 71 publications

(78 citation statements)

References 37 publications

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“…In these analyses, patients were followed from the date of first treatment for ESRD until the date of death, transplantation, or end of follow-up (September 30, 2007). Multivariate models incorporated recipient age, gender, race, cause of ESRD, body mass index (BMI), comorbid disease conditions (ischemic heart disease, stroke, peripheral vascular disease, congestive heart failure, chronic obstructive pulmonary disease), ambulatory status, history of smoking or substance abuse, state-level rate of deceased organ donation per million population (6), median household income, and primary source of medical insurance as described previously (6,7).…”

Section: Methodsmentioning

confidence: 99%

Access to Kidney Transplantation among the Elderly in the United States

Schaeffner¹,

Rose²,

Gill³

2010

Clinical Journal of the American Society of Nephrology

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Section: Methodsmentioning

confidence: 99%

Access to Kidney Transplantation among the Elderly in the United States

Schaeffner¹,

Rose²,

Gill³

2010

Clinical Journal of the American Society of Nephrology

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“…Assuming that improving access to nephrology care by reducing travel time would lead to improved outcomes and lower hospitalization rates, as suggested by observational studies (1)(2)(3)(4)(5)(6)(7)(8)(9), establishing this additional clinic would represent good value for money, with ICURs ranging from $4000 to $8000/QALY in most scenarios. However, if reducing distance to specialized care does not reduce the risk of hospitalization or mortality, the cost-effectiveness of establishing a new clinic may be considerably less attractive-although it still might be economically attractive by current standards.…”

Section: Discussionmentioning

confidence: 99%

“…Although kidney disease occurs throughout the province, specialized renal care is provided in 17 clinics that are predominantly located in the more densely populated southern half of Alberta ( Figure 1). Multiple studies (1)(2)(3)(4)(5)(6)(7)(8)(9) have shown that distance from health services is inversely associated with clinical benefits. We recently showed (10) that markers of good-quality care in CKD patients in Alberta decreased with increasing distance from the practice location of the closest nephrologist.…”

Section: Introductionmentioning

confidence: 99%

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

Wiebe

Klarenbach

Chui

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study aimed to determine whether opening a new clinic in a remote region would be a cost-effective means of improving care for remote-dwellers with CKD.Design, setting, participants, & measurements This study is a cost-utility analysis from a public payer's perspective over a lifetime horizon, using administrative data from a large cohort of adults with stage 3b-4 CKD in Alberta, Canada. The association between the distance from each simulated patient's residence and the practice location of the closest nephrologist and clinical outcomes (quality of care, hospitalization, dialysis, and death) were examined. A Markov 6-month cycle economic decision model was analyzed; estimates of the effect of a new clinic were based on the association between residence location, resource use, and outcomes. Costs are reported in 2009 Canadian dollars.Results The costs for equipping and operating a clinic for 321 remote-dwelling patients were estimated at $25,000 and $250,000/yr, respectively. The incremental cost-utility ratios (ICURs) ranged from $4000 to $8000/qualityadjusted life-year under most scenarios. However, if reducing distance to nephrologist care does not alter mortality or hospitalization among remote-dwellers, the cost-effectiveness becomes less attractive. All other one-way sensitivity analyses had negligible effects on the ICUR.Conclusions Given the low costs of equipping and operating new clinics, and the very attractive ICUR relative to other currently funded interventions, establishing new clinics for remote-dwellers could play an important role in efficiently improving outcomes for patients with CKD. High-quality controlled studies are required to confirm this hypothesis.

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“…For example, factors, such as the supply, training, and availability of health care providers, as well as physical determinants, such as the proximity and resources of health care facilities, have been associated with care access and delivery before and after ESRD onset (18)(19)(20). The study by Yan et al (9) did not adequately assess these issues.…”

mentioning

confidence: 99%