High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System

Stephens, J. Mark; Brotherton, Samuel; Dunning, Stephan; Emerson, Larry C.; Gilbertson, David T.; Gitlin, Matthew; McClellan, Ann C.; McClellan, William M.; Shreay, Sanatan

doi:10.36469/9861

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…Significant cost savings may also be realized by reducing transportation costs to in-center facilities by enabling patients in nursing facilities or with significant disabilities to perform PD who would otherwise not have that option. 42 RPM may provide a way for these patients to safely dialyze at home without the added need of transportation. Finally, in many areas of the world, there are limited health care providers to care for large populations of patients.…”

Section: Methodsmentioning

confidence: 99%

Remote Patient Management for Home Dialysis Patients

Wallace

Rosner

Alscher

et al. 2017

Kidney International Reports

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Remote patient management (RPM) offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.

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Section: Methodsmentioning

confidence: 99%

Remote Patient Management for Home Dialysis Patients

Wallace

Rosner

Alscher

et al. 2017

Kidney International Reports

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“…Costs of matching donors and recipients for kidney transplant among individuals with ADPKD were based on the Organ Procurement and Transplantation Network (OPTN) fees and the United Network for Organ Sharing (UNOS) fees multiplied by the number of individuals waiting for a kidney transplant due to ADPKD [16,[33][34][35]. Costs of transportation to and from dialysis centers among individuals with ADPKD in the US were based on the average transportation costs for individuals using in-center dialysis multiplied by the number of individuals with ADPKD using in-center dialysis in the US [12,16]. The number of individuals with ADPKD using in-center dialysis in the US was computed as the number of individuals with ESRD-RRT requiring dialysis due to cystic kidney disease in the US multiplied by the proportion of individuals with ESRD-RRT due to ADPKD among individuals with cystic kidney disease and the proportion of individuals requiring incenter dialysis among individuals requiring dialysis due to cystic kidney disease [16].…”

Section: Direct Non-healthcare Costsmentioning

confidence: 99%

“…Given that ADPKD is a life-long and progressive disorder, a substantial economic burden over the course of the disease is expected, including a variety of treatmentrelated and other costs [6][7][8][9][10][11][12][13]. Few studies to date have estimated direct and indirect costs among patients with ADPKD.…”

Section: Introductionmentioning

confidence: 99%

The societal economic burden of autosomal dominant polycystic kidney disease in the United States

Cloutier

Manceur

Guérin

et al. 2020

BMC Health Serv Res

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Background: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases characterized by progressive development of renal cysts and numerous extra-renal manifestations, eventually leading to kidney failure. Given its chronic and progressive nature, ADPKD is expected to carry a substantial economic burden over the course of the disease. However, there is a paucity of evidence on the impact of ADPKD from a societal perspective. This study aimed to estimate the direct and indirect costs associated with ADPKD in the United States (US). Methods: A prevalence-based approach using data from scientific literature, and governmental and nongovernmental organizations was employed to estimate direct healthcare costs (i.e., medical services, prescription drugs), direct non-healthcare costs (i.e., research and advocacy, donors/recipients matching for kidney transplants, transportation to/from dialysis centers), and indirect costs (i.e., patient productivity loss from unemployment, reduced work productivity, and premature mortality, caregivers' productivity loss and healthcare costs). The incremental costs associated with ADPKD were calculated as the difference between costs incurred over a one-year period by individuals with ADPKD and the US population. Sensitivity analyses using different sources and assumptions were performed to assess robustness of estimates and account for variability in published estimates. Results: The estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with ADPKD. In the base scenario, direct healthcare costs accounted for $5.7 billion (78.6%) of the total $7.3 billion costs, mostly driven by patients requiring renal replacement therapy ($3.2 billion; 43.3%). Indirect costs accounted for $1.4 billion (19.7%), mostly driven by productivity loss due to unemployment ($784 million; 10.7%) and reduced productivity at work ($390 million; 5.3%). Total excess direct non-healthcare costs were estimated at $125 million (1.7%). Conclusions: ADPKD carries a considerable economic burden, predominantly attributed to direct healthcare costs, the majority of which are incurred by public and private healthcare payers. Effective and timely interventions to slow down the progression of ADPKD could substantially reduce the economic burden of ADPKD.

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“…In order to guide future reimbursement decisions, there is great need for studies that assess an endpoint of overall resource utilization including reduction in nonemergent transportation costs. For the latter, it has been estimated that annually almost $3 billion is spent on this for patients receiving dialysis (48). Furthermore, studies evaluating clinical outcomes and economic analyses associated with reduction in hospitalizations and rehospitalizations, technique failure, and peritonitis rates should also be undertaken to guide reimbursement.…”

Section: Evidence Generation and Regulatory Issuesmentioning

confidence: 99%

Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT

Rosner

Lew

Conway

et al. 2017

CJASN

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Telehealth and remote monitoring of a patient's health status has become more commonplace in the last decade and has been applied to conditions such as heart failure, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Conversely, uptake of these technologies to help engender and support home RRTs has lagged. Although studies have looked at the role of telehealth in RRT, they are small and single-centered, and both outcome and cost-effectiveness data are needed to inform future decision making. Furthermore, alignment of payer and government (federal and state) regulations with telehealth procedures is needed along with a better understanding of the viewpoints of the various stakeholders in this process (patients, caregivers, clinicians, payers, dialysis organizations, and government regulators). Despite these barriers, telehealth has great potential to increase the acceptance of home dialysis, and improve outcomes and patient satisfaction while potentially decreasing costs. The Kidney Health Initiative convened a multidisciplinary workgroup to examine the current state of telehealth use in home RRTs as well as outline potential benefits and drawbacks, impediments to implementation, and key unanswered questions.

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High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System

Cited by 8 publications

References 16 publications

Remote Patient Management for Home Dialysis Patients

Remote Patient Management for Home Dialysis Patients

The societal economic burden of autosomal dominant polycystic kidney disease in the United States

Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT

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