The cost of renal dialysis in a UK settinga multicentre study
Identifieur interne : 000E46 ( Istex/Corpus ); précédent : 000E45; suivant : 000E47The cost of renal dialysis in a UK settinga multicentre study
Auteurs : Keshwar Baboolal ; Philip Mcewan ; Seema Sondhi ; Piotr Spiewanowski ; Jaroslaw Wechowski ; Karen WilsonSource :
- Nephrology Dialysis Transplantation [ 0931-0509 ] ; 2008-06.
Abstract
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 21655 and 15570, respectively. Hospital-based haemodialysis (HD) cost 35023 per annum and satellite-unit-based HD cost 32669. The cost of home-based HD was 20764 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.
Url:
DOI: 10.1093/ndt/gfm870
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ISTEX:78D25D088A6BC4848D479C2E6D5CD044D5BF6A3DLe document en format XML
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Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Mcewan, Philip" sort="Mcewan, Philip" uniqKey="Mcewan P" first="Philip" last="Mcewan">Philip Mcewan</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Sondhi, Seema" sort="Sondhi, Seema" uniqKey="Sondhi S" first="Seema" last="Sondhi">Seema Sondhi</name><affiliation><mods:affiliation>Baxter Healthcare, Compton, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Spiewanowski, Piotr" sort="Spiewanowski, Piotr" uniqKey="Spiewanowski P" first="Piotr" last="Spiewanowski">Piotr Spiewanowski</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Wechowski, Jaroslaw" sort="Wechowski, Jaroslaw" uniqKey="Wechowski J" first="Jaroslaw" last="Wechowski">Jaroslaw Wechowski</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Wilson, Karen" sort="Wilson, Karen" uniqKey="Wilson K" first="Karen" last="Wilson">Karen Wilson</name><affiliation><mods:affiliation>Baxter Healthcare, Compton, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. 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Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Mcewan, Philip" sort="Mcewan, Philip" uniqKey="Mcewan P" first="Philip" last="Mcewan">Philip Mcewan</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Sondhi, Seema" sort="Sondhi, Seema" uniqKey="Sondhi S" first="Seema" last="Sondhi">Seema Sondhi</name><affiliation><mods:affiliation>Baxter Healthcare, Compton, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Spiewanowski, Piotr" sort="Spiewanowski, Piotr" uniqKey="Spiewanowski P" first="Piotr" last="Spiewanowski">Piotr Spiewanowski</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Wechowski, Jaroslaw" sort="Wechowski, Jaroslaw" uniqKey="Wechowski J" first="Jaroslaw" last="Wechowski">Jaroslaw Wechowski</name><affiliation><mods:affiliation>Cardiff Research Consortium, Cardiff, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author><author><name sortKey="Wilson, Karen" sort="Wilson, Karen" uniqKey="Wilson K" first="Karen" last="Wilson">Karen Wilson</name><affiliation><mods:affiliation>Baxter Healthcare, Compton, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Nephrology Dialysis Transplantation</title><title level="j" type="abbrev">Nephrol Dial Transplant</title><idno type="ISSN">0931-0509</idno><idno type="eISSN">1460-2385</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-06">2008-06</date><biblScope unit="volume">23</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1982">1982</biblScope><biblScope unit="page" to="1989">1989</biblScope></imprint><idno type="ISSN">0931-0509</idno></series><idno type="istex">78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D</idno><idno type="DOI">10.1093/ndt/gfm870</idno><idno type="ArticleID">gfm870</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0931-0509</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">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 21655 and 15570, respectively. Hospital-based haemodialysis (HD) cost 35023 per annum and satellite-unit-based HD cost 32669. The cost of home-based HD was 20764 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.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Keshwar Baboolal</name><affiliations><json:string>Department of Nephrology and Transplantation, University Hospital of Wales, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item><json:item><name>Philip McEwan</name><affiliations><json:string>Cardiff Research Consortium, Cardiff, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item><json:item><name>Seema Sondhi</name><affiliations><json:string>Baxter Healthcare, Compton, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item><json:item><name>Piotr Spiewanowski</name><affiliations><json:string>Cardiff Research Consortium, Cardiff, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item><json:item><name>Jaroslaw Wechowski</name><affiliations><json:string>Cardiff Research Consortium, Cardiff, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item><json:item><name>Karen Wilson</name><affiliations><json:string>Baxter Healthcare, Compton, UK</json:string><json:string>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>cost</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>haemodialysis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>health economics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>peritoneal dialysis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>renal failure</value></json:item></subject><articleId><json:string>gfm870</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>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 21655 and 15570, respectively. Hospital-based haemodialysis (HD) cost 35023 per annum and satellite-unit-based HD cost 32669. The cost of home-based HD was 20764 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.</abstract><qualityIndicators><score>8</score><pdfVersion>1.2</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1772</abstractCharCount><pdfWordCount>5595</pdfWordCount><pdfCharCount>33935</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>276</abstractWordCount></qualityIndicators><title>The cost of renal dialysis in a UK settinga multicentre study</title><genre><json:string>research-article</json:string></genre><host><volume>23</volume><publisherId><json:string>ndt</json:string></publisherId><pages><last>1989</last><first>1982</first></pages><issn><json:string>0931-0509</json:string></issn><issue>6</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1460-2385</json:string></eissn><title>Nephrology Dialysis Transplantation</title></host><categories><wos><json:string>TRANSPLANTATION</json:string><json:string>UROLOGY & NEPHROLOGY</json:string></wos></categories><publicationDate>2008</publicationDate><copyrightDate>2008</copyrightDate><doi><json:string>10.1093/ndt/gfm870</json:string></doi><id>78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D</id><score>0.24937814</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">The cost of renal dialysis in a UK settinga multicentre study</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>The Author [2008]. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p></availability><date>2008-01-03</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">The cost of renal dialysis in a UK settinga multicentre study</title><author xml:id="author-1"><persName><forename type="first">Keshwar</forename><surname>Baboolal</surname></persName><affiliation>Department of Nephrology and Transplantation, University Hospital of Wales, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author><author xml:id="author-2"><persName><forename type="first">Philip</forename><surname>McEwan</surname></persName><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author><author xml:id="author-3"><persName><forename type="first">Seema</forename><surname>Sondhi</surname></persName><affiliation>Baxter Healthcare, Compton, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author><author xml:id="author-4"><persName><forename type="first">Piotr</forename><surname>Spiewanowski</surname></persName><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author><author xml:id="author-5"><persName><forename type="first">Jaroslaw</forename><surname>Wechowski</surname></persName><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author><author xml:id="author-6"><persName><forename type="first">Karen</forename><surname>Wilson</surname></persName><affiliation>Baxter Healthcare, Compton, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation></author></analytic><monogr><title level="j">Nephrology Dialysis Transplantation</title><title level="j" type="abbrev">Nephrol Dial Transplant</title><idno type="pISSN">0931-0509</idno><idno type="eISSN">1460-2385</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-06"></date><biblScope unit="volume">23</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1982">1982</biblScope><biblScope unit="page" to="1989">1989</biblScope></imprint></monogr><idno type="istex">78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D</idno><idno type="DOI">10.1093/ndt/gfm870</idno><idno type="ArticleID">gfm870</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008-01-03</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>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 21655 and 15570, respectively. Hospital-based haemodialysis (HD) cost 35023 per annum and satellite-unit-based HD cost 32669. The cost of home-based HD was 20764 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.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>cost</term></item><item><term>haemodialysis</term></item><item><term>health economics</term></item><item><term>peritoneal dialysis</term></item><item><term>renal failure</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-01-03">Created</change><change when="2008-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="publisher-id">ndt</journal-id><journal-id journal-id-type="hwp">ndt</journal-id><journal-title>Nephrology Dialysis Transplantation</journal-title><abbrev-journal-title abbrev-type="pubmed">Nephrol Dial Transplant</abbrev-journal-title><issn pub-type="ppub">0931-0509</issn><issn pub-type="epub">1460-2385</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/ndt/gfm870</article-id><article-id pub-id-type="publisher-id">gfm870</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>The cost of renal dialysis in a UK setting—a multicentre study</article-title><alt-title alt-title-type="left-running">K. Baboolal <italic>et al.</italic></alt-title><alt-title alt-title-type="right-running">Cost of dialysis in UK</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Baboolal</surname><given-names>Keshwar</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>McEwan</surname><given-names>Philip</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Sondhi</surname><given-names>Seema</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Spiewanowski</surname><given-names>Piotr</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wechowski</surname><given-names>Jaroslaw</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wilson</surname><given-names>Karen</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Nephrology and Transplantation</addr-line>, <institution>University Hospital of Wales</institution>, <country>UK</country></aff><aff id="af2"><label>2</label><addr-line>Cardiff Research Consortium, Cardiff</addr-line>, <country>UK</country></aff><aff id="af3"><label>3</label><addr-line>Baxter Healthcare, Compton</addr-line>, <country>UK</country></aff><author-notes><corresp>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: <phone>+44-2920-748-410</phone>; Fax: <fax>+44-2920-746-664</fax>; E-mail: <email>BaboolalK@cf.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2008</year></pub-date><pub-date pub-type="epub"><day>3</day><month>1</month><year>2008</year></pub-date><volume>23</volume><issue>6</issue><fpage>1982</fpage><lpage>1989</lpage><history><date date-type="received"><day>10</day><month>8</month><year>2007</year></date><date date-type="accepted"><day>15</day><month>11</month><year>2007</year></date></history><permissions><copyright-statement>© The Author [2008]. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2008</copyright-year><copyright-holder>Oxford University Press</copyright-holder></permissions><abstract><p><bold>Background.</bold> 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.</p><p><bold>Methods.</bold> 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.</p><p><bold>Results.</bold> 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.</p><p><bold>Conclusions.</bold> 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.</p></abstract><kwd-group><title>Keywords</title><kwd>cost</kwd><kwd>haemodialysis</kwd><kwd>health economics</kwd><kwd>peritoneal dialysis</kwd><kwd>renal failure</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>The cost of renal dialysis in a UK settinga multicentre study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>The cost of renal dialysis in a UK settinga multicentre study</title></titleInfo><name type="personal"><namePart type="given">Keshwar</namePart><namePart type="family">Baboolal</namePart><affiliation>Department of Nephrology and Transplantation, University Hospital of Wales, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Philip</namePart><namePart type="family">McEwan</namePart><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Seema</namePart><namePart type="family">Sondhi</namePart><affiliation>Baxter Healthcare, Compton, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Piotr</namePart><namePart type="family">Spiewanowski</namePart><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jaroslaw</namePart><namePart type="family">Wechowski</namePart><affiliation>Cardiff Research Consortium, Cardiff, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Wilson</namePart><affiliation>Baxter Healthcare, Compton, UK</affiliation><affiliation>Correspondence and offprint requests to: Keshwar Baboolal, Department of Nephrology and Transplantation, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Tel: 44-2920-748-410; Fax: 44-2920-746-664;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2008-06</dateIssued><dateCreated encoding="w3cdtf">2008-01-03</dateCreated><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>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 21655 and 15570, respectively. Hospital-based haemodialysis (HD) cost 35023 per annum and satellite-unit-based HD cost 32669. The cost of home-based HD was 20764 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.</abstract><subject><genre>Keywords</genre><topic>cost</topic><topic>haemodialysis</topic><topic>health economics</topic><topic>peritoneal dialysis</topic><topic>renal failure</topic></subject><relatedItem type="host"><titleInfo><title>Nephrology Dialysis Transplantation</title></titleInfo><titleInfo type="abbreviated"><title>Nephrol Dial Transplant</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0931-0509</identifier><identifier type="eISSN">1460-2385</identifier><identifier type="PublisherID">ndt</identifier><identifier type="PublisherID-hwp">ndt</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>23</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>1982</start><end>1989</end></extent></part></relatedItem><identifier type="istex">78D25D088A6BC4848D479C2E6D5CD044D5BF6A3D</identifier><identifier type="DOI">10.1093/ndt/gfm870</identifier><identifier type="ArticleID">gfm870</identifier><accessCondition type="use and reproduction" contentType="copyright">The Author [2008]. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. 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