A call for harmonization of European kidney care: dialysis reimbursement and distribution of kidney replacement therapies
- 30 March 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 35 (6), 979-986
- https://doi.org/10.1093/ndt/gfaa035
Abstract
Background We compare reimbursement for haemodialysis (HD) and peritoneal dialysis (PD) in European countries to assess the impact on government healthcare budgets. We discuss strategies to reduce costs by promoting sustainable dialysis and kidney transplantation. Methods This was a cross-sectional survey among nephrologists conducted online July–December 2016. European countries were categorized by tertiles of gross domestic product per capita (GDP). Reimbursement data were matched to kidney replacement therapy (KRT) data. Results The prevalence per million population of patients being treated with long-term dialysis was not significantly different across tertiles of GDP (P = 0.22). The percentage of PD increased with GDP across tertiles (4.9, 8.2, 13.4%; P < 0.001). The HD-to-PD reimbursement ratio was higher in countries with the highest tertile of GDP (0.7, 1.0 versus 1.7; P = 0.007). Home HD was mainly reimbursed in countries with the highest tertile of GDP (15, 15 versus 69%; P = 0.005). The percentage of public health expenditure for reimbursement of dialysis decreased across tertiles of GDP (3.3, 1.5, 0.7%; P < 0.001). Transplantation as a proportion of all KRT increased across tertiles of GDP (18.5, 39.5, 56.0%; P < 0.001). Conclusions In Europe, dialysis has a disproportionately high impact on public health expenditure, especially in countries with a lower GDP. In these countries, the cost difference between PD and HD is smaller, and home dialysis and transplantation are less frequently provided than in countries with a higher GDP. In-depth evaluation and analysis of influential economic and political measures are needed to steer optimized reimbursement strategies for KRT.Funding Information
- Australian National Health and Medical Research Council (#1150989)
This publication has 28 references indexed in Scilit:
- Chronic kidney disease: global dimension and perspectivesThe Lancet, 2013
- Cost of peritoneal dialysis and haemodialysis across the worldNephrology Dialysis Transplantation, 2013
- Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicatorsNephrology Dialysis Transplantation, 2013
- Development of the Croatian model of organ donation and transplantationCroatian Medical Journal, 2013
- A Systematic Review and Meta-Analysis of Utility-Based Quality of Life in Chronic Kidney Disease TreatmentsPLoS Medicine, 2012
- Reimbursement of DialysisJournal of the American Society of Nephrology, 2012
- Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-MorbiditiesPLOS ONE, 2012
- Economic Evaluation of Dialysis TherapiesSeminars in Nephrology, 2009
- An Empiric Estimate of the Value of Life: Updating the Renal Dialysis Cost-Effectiveness StandardValue in Health, 2009