Journal Article

The cost of renal dialysis in a UK setting—a multicentre study

Keshwar Baboolal, Philip McEwan, Seema Sondhi, Piotr Spiewanowski, Jaroslaw Wechowski and Karen Wilson

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 6, pages 1982-1989
Published in print June 2008 | ISSN: 0931-0509
Published online January 2008 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm870
The cost of renal dialysis in a UK setting—a multicentre study

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Background. The UK National Health Service (NHS) will fund renal services using Payment by Results (PbR), from 2009. Central to the success of PbR will be the creation of tariffs that reflect the true cost of medical services. We have therefore estimated the cost of different dialysis modalities in the Cardiff and Vale NHS Trust and six other hospitals in the UK.

Methods. We used semi-structured interviews with nephrologists, head nurses and business managers to identify the steps involved in delivering the different dialysis modalities. We assigned costs to these using published figures or suppliers’ published price lists. The study used mixed costing methods. Dialysis costs were estimated by a combination of microcosting and a top-down approach. Where we did not have access to detailed accounts, we applied values for Cardiff.

Results. The most efficient modalities were automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD), the mean annual costs of which were £21 655 and £15 570, respectively. Hospital-based haemodialysis (HD) cost £35 023 per annum and satellite-unit-based HD cost £32 669. The cost of home-based HD was £20 764 per year (based on data from only one unit). The main cost drivers for PD were the costs of solutions and management of anaemia. For HD they were costs of disposables, nursing, the overheads associated with running the unit and management of anaemia.

Conclusions. Renal tariffs for PbR need to reflect the true cost of dialysis provision if choices about modalities are not to be influenced by erroneous estimates of cost. Knowledge of the true costs of modalities will also maximize the number of established renal failure patients treated by dialysis within the limited funds available from the NHS.

Keywords: cost; haemodialysis; health economics; peritoneal dialysis; renal failure

Journal Article.  5438 words.  Illustrated.

Subjects: Nephrology

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