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Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis

BACKGROUND: Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service p...

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Autores principales: Gorham, G., Howard, K., Zhao, Y., Ahmed, A. M. S., Lawton, P. D., Sajiv, C., Majoni, S. W., Wood, P., Conlon, T., Signal, S., Robinson, S. L., Brown, S., Cass, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593509/
https://www.ncbi.nlm.nih.gov/pubmed/31238898
http://dx.doi.org/10.1186/s12882-019-1421-z
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author Gorham, G.
Howard, K.
Zhao, Y.
Ahmed, A. M. S.
Lawton, P. D.
Sajiv, C.
Majoni, S. W.
Wood, P.
Conlon, T.
Signal, S.
Robinson, S. L.
Brown, S.
Cass, A.
author_facet Gorham, G.
Howard, K.
Zhao, Y.
Ahmed, A. M. S.
Lawton, P. D.
Sajiv, C.
Majoni, S. W.
Wood, P.
Conlon, T.
Signal, S.
Robinson, S. L.
Brown, S.
Cass, A.
author_sort Gorham, G.
collection PubMed
description BACKGROUND: Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia’s Northern Territory (NT). METHODS: We undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars. RESULTS: There was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies. CONCLUSION: The cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1421-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-65935092019-07-09 Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis Gorham, G. Howard, K. Zhao, Y. Ahmed, A. M. S. Lawton, P. D. Sajiv, C. Majoni, S. W. Wood, P. Conlon, T. Signal, S. Robinson, S. L. Brown, S. Cass, A. BMC Nephrol Research Article BACKGROUND: Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia’s Northern Territory (NT). METHODS: We undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars. RESULTS: There was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies. CONCLUSION: The cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1421-z) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-25 /pmc/articles/PMC6593509/ /pubmed/31238898 http://dx.doi.org/10.1186/s12882-019-1421-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Gorham, G.
Howard, K.
Zhao, Y.
Ahmed, A. M. S.
Lawton, P. D.
Sajiv, C.
Majoni, S. W.
Wood, P.
Conlon, T.
Signal, S.
Robinson, S. L.
Brown, S.
Cass, A.
Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title_full Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title_fullStr Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title_full_unstemmed Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title_short Cost of dialysis therapies in rural and remote Australia – a micro-costing analysis
title_sort cost of dialysis therapies in rural and remote australia – a micro-costing analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593509/
https://www.ncbi.nlm.nih.gov/pubmed/31238898
http://dx.doi.org/10.1186/s12882-019-1421-z
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