Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease

Couchoud, Cécile; Couillerot, Anne-Line; Dantony, Emmanuelle; Elsensohn, Mad-Hélénie; Labeeuw, M; Villar, Emmanuel; Écochard, René; Bongiovanni, Isabelle

doi:10.1093/ndt/gfv300

Cited by 32 publications

(11 citation statements)

References 18 publications

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“…Patients with ESRD need renal replacement therapy (haemodialysis, peritoneal dialysis or renal transplantation) to improve their survival. Renal transplantation is associated with better survival [1–3], better quality of life [4, 5] and lower cost [6] compared with dialysis. However, access to renal transplantation is often limited by organ shortage [7].…”

Section: Introductionmentioning

confidence: 99%

Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions

et al. 2016

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BackgroundIn France, there are important regional disparities of access to the renal transplant waiting list and transplantation. Our objectives were to compare the characteristics of patients with end-stage renal disease (ESRD) of two French regions (Ile-de-France and Bretagne) and to identify determinants of access to the waiting list and subsequent transplantation, with a focus on temporary inactive status (TIS) periods.MethodsAll 18–80-year-old incident patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 were included (n = 6160). Associations between patients' characteristics and placement on the waiting list or transplantation were assessed using a Fine and Gray model to take into account the competing risk of death and living donor transplantation.ResultsAt the end of the follow-up (31 December 2013), more patients had undergone transplantation in Bretagne than in Ile-de-France (30 versus 27%), although the percentage of waitlisted patients was higher in Ile-de-France than in Bretagne (47 versus 33%). More patients were on TIS and with a longer median TIS duration in Ile-de-France. Independent of age and clinical characteristics, patients in Bretagne were less likely to be waitlisted than those in Ile-de-France [subdistribution hazard ratio 0.77 (95% confidence interval 0.7–0.9)]. After waitlisting, patients in Bretagne were four times more likely to be transplanted.ConclusionsOur study highlights clinical practice differences in Bretagne and Ile-de-France and shows that facilitating access to the waiting list is not sufficient to improve access to renal transplantation, which also depends on organ availability.

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Section: Introductionmentioning

confidence: 99%

Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions

et al. 2016

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“…Information provided to patients by nephrologists and other renal unit staff plays an important role when older adults are choosing between dialysis and conservative management [33], but according to the study from the Netherlands the decision seems to be based on personal values, beliefs and feelings toward life, suffering, and expected difficulties on RRT, rather than on the effectiveness of the treatment [34]. Dialysis is expensive, especially among elderly, and is estimated to cost up to 90 000 euros annually for each patient [35]. Therefore, the decision to start dialysis in an elderly patient with substantial comorbidity should only be made after careful consideration and the patient should be involved in the decision-making [36,37].…”

Section: Discussionmentioning

confidence: 99%

Factors associating with differences in the incidence of renal replacement therapy among elderly: data from the ERA-EDTA Registry

Helve

Kramer

Díez

et al. 2018

Nephrology Dialysis Transplantation

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“…Moreover, apart from hospital databases, some studies took patients' feelings into account via interviews and questionnaires. Some studies required additional information on, for instance, medication [31,58] through pharmacy databases or non-hospital care [59,60] with social security databases for complete patient care monitoring.…”

Section: Discussionmentioning

confidence: 99%

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Pinaire

Azé

Bringay

et al. 2017

Health Inf Sci Syst

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Background: Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves.Methods: We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions.Results: Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). Conclusion:This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.

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Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease

Cited by 32 publications

References 18 publications

Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions

Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions

Factors associating with differences in the incidence of renal replacement therapy among elderly: data from the ERA-EDTA Registry

Patient healthcare trajectory. An essential monitoring tool: a systematic review

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