Cost analysis of integrated renal replacement therapy program in the province of Toledo (2012–2013)

Background: Renal replacement therapy (RRT) is the object of constant analysis in the search for efficiency and sustainability. Objective: To calculate the direct cost of healthcare for the prevalent RRT population in the province of Toledo (2012/2013). Method: (a) Population: All prevalent patients at some point in RRT in 2012 (669) and in 2013 (682). (b) Costs included (€): (1) dialysis procedure; (2) inpatient, outpatient and emergency care, dialysis and non-dialysis related; (3) drug consumption; (4) medical transport. (c) Calculation and analysis: The aggregate localized or reconstructed cost of each item was calculated from the individual cost of each patient. Annual cost and cost per patient/year was calculated for the whole RRT and for its subprograms (€). Results: (a) Aggregate costs: The total cost of RRT amounted to 15.84 and 15.77 million euros (2012/2013). Dialysis procedures account for 40.2% of the total while the sum of hospital care and drug consumption represents 41.5%. Healthcare for patients on hospital haemodialysis (HHD) and concerted haemodialysis (CHD), peritoneal dialysis (PD) and transplant (Tx) accounts for 70.0, 5.0 and 25.0% of the total respectively. (b) Patient/year cost: From the number of patients/year provided by each subprogramme, the following values were obtained in 2012/2013: All RRT 26,130/25,379; HHD 49,167/53,289; CHD 44,657/44,971; PD 45,538/51,869 and Tx 10,909/10,984. Conclusions: Our results are consistent with others published, although our patient/year values are slightly higher, probably because they include elements such as outpatient pharmacy, hospital and medical transport cargo. The growing contribution of Tx to the survival of the whole RRT population contains the overall costs and reduces the patient/year cost, making RRT sustainable.