Abstract
One of the most critical policy issues in the last years has been the rising cost of health care and the efficiency and effectiveness of resource use. At the same time, it has been established that, while health technology is a major cost driving factor, its appropriate utilization also improves the quality and effectiveness of care. As far as End Stage Renal Disease is concerned, the technology of hemodialysis seems to be a well established form of treatment. Yet, major problems arise due to the high cost (direct and indirect) of this method and the frequency of the treatments needed (normally four hours three times per week). Existing evidence from the international literature along with the absence of estimates of the actual cost of inpatient dialysis, points to the need for an economic evaluation study of the cost of the dialysis in a national setting. In this study, we estimated the cost of hemodialysis treatment in a public hospital setting, along with the lost productivity cost ...
One of the most critical policy issues in the last years has been the rising cost of health care and the efficiency and effectiveness of resource use. At the same time, it has been established that, while health technology is a major cost driving factor, its appropriate utilization also improves the quality and effectiveness of care. As far as End Stage Renal Disease is concerned, the technology of hemodialysis seems to be a well established form of treatment. Yet, major problems arise due to the high cost (direct and indirect) of this method and the frequency of the treatments needed (normally four hours three times per week). Existing evidence from the international literature along with the absence of estimates of the actual cost of inpatient dialysis, points to the need for an economic evaluation study of the cost of the dialysis in a national setting. In this study, we estimated the cost of hemodialysis treatment in a public hospital setting, along with the lost productivity cost of these patients (loss of income) which was particularly difficult exercise, but in the case of end-stage renal disease this item enters the cost structure in a rather decisive way, since absence from or even loss of work are fairly common outcomes of the disease. Material and methods: A socioeconomic analysis was performed attempting the economic evaluation of: a) the health care resources consumed in order to provide hemodialysis therapy for ESRD patients and b) the lost productivity cost of the patient and their family due to illness. The direct cost of illness was estimated in “G. Gennimatas” Hospital of Athens, which includes a dialysis unit currently providing ESRD care for 26 permanent patients utilizing 9 hemodialysis stations. The unit operates six days a week for ten hours/day performing approximately 7,000 hemodialysis treatments per year (for the permanent and the non-permanent patients. The study was carried out from a societal perspective. In addition to direct medical and non-medical costs, lost productivity costs often have a substantial impact on the total cost-of-illness. According to the recent Canadian Guidelines, indirect costs are the value of production lost as a result of the illness or the treatment process. In this study we estimated the lost productivity costs for the patient with both the human capital approach and the friction method. Indirect morbidity costs due to absence from work, long-term disability necessitating a change in type of work, or early retirement were estimated as well as mortality costs. Cost data expressed in 1999 Greek drachmas and euro, were collected from a sample of 128 patients. Mean gross income was used for both patient and family. Results: It was estimated that hemodialysis costs more than 62,000dr. (182 Euro) per treatment and the hospitalization more than 78.000dr/inpatient day (229 Euro). 46,1% of the patients were hospitalized for 8,5 days in the Nephrological Unit of the hospital (95%confidence interval:3,2-13,7, standard deviation: 8,3). The total direct cost of hemodialysis was estimated at 58,5 billion dr. (171.8 Euro) in 1999 constituting appoximately 2% of the national health expenditure in Greece. In 1999, 15.180 years potential years of life lost were attributable to ESRD. To derive this estimate, deaths caused by ESRD were weighted by the estimated years of life expectancy at the time of death for each age group. To estimate production losses caused by mortality due to ESRD in the same year, the number of working years left was multiplied by the mean annual earnings and then it was adjusted for economic activity and unemployment, before it was discounted at 3 per cent per annum. Assuming a working life of 65 for men and 60 for women the potential years of productivity lost due to mortality were, according human capital approach, 2,046 years leading to a cost of 3,5 billion dr. (9,9 million Euro).According the friction method mortality cost were not estimated over 103 million dr. (303.000 euro). The total morbidity cost due to absence from work and early retirement (36,7% of the studied population retired prematurely) was estimated to be more than 90 billion dr. (273 million Euro) according to Human Capital Approach though according the Friction Method morbidity cost was estimated to be less than 4,5 billion dr. (12,5 million Euro), that is 95,4% less than the human capital approach. Finally, a statistical significant association was found between premature retirement of patients and the place of living, the occupation and the educational level (p<5%).
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