End Stage Renal Disease Economics and the Balance of Treatment Modalities

John D. Sullivan
DOI: 10.4236/jssm.2010.31005                

Abstract

Periodically, research articles emerge arguing the economic benefits of peritoneal dialysis, or PD, over the traditional in-center hemo dialysis for patients suffering from End Stage Renal Disease. Resulting conclusions indentify PD as the ideal therapy to reduce Medicare expenditures for this expensive treatment. However, despite this possible economic benefit to the United States taxpayer, the number of PD patients remains relatively flat with an increasing amount of patients being prescribed in-center hemo dialysis. A simplistic view of controlling the rising costs, on a per treatment basis, associated with the treatment of this disease would be to increase the number of patients from in-center hemo dialysis to peritoneal dialysis. This paper will argue why this shift is both unlikely and unrealistic, and why the resulting potential cost savings to this segment of the Medicare program is a myth.

Keywords

End Stage Renal Disease, Dialysis, Medicare, Reimbursement, Economics, Mergers, Acquisitions

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	National Kidney Foundation. Chronic kidney Disease (CKD), The facts about chronic kidney disease (CKD), May 26, 2009, http://www.kidney.org/kidneydisease/ckd/index.cfm.
[2]	N. Tareen, et al., “Chronic kidney disease in African American and Mexican American populations,” Kidney International, No. 68, pp. S137–S140, 2005.
[3]	N. Burrows, Y. Li, and D. Williams, “Racial and ethnic differences in trends of end stage renal disease: United States 1995 to 2005,” Advances in Chronic Kidney Disease, Vol. 15, No. 2, pp. 147–152.
[4]	United Network for Organ Sharing, View Data Reports, National Data, Transplants by Donor Type, Kidney, May 25, 2009, http://optn.transplant.hrsa.gov/latestData/rptData.asp.
[5]	K. Howard, et al., “The cost effectiveness of increasing kidney transplantation and home based dialysis,” Nephrology, Vol. 14, No. 1, pp. 123–132, 2009.
[6]	E. Yen, et al., “Cost effectiveness of extending Medicare coverage of immunosuppressive medications to the life of a kidney transplant,” American Journal of Transplantation, Vol. 4, No. 10, pp. 1703–1708, 2004.
[7]	R. Saran, et al., “Longer treatment time and slower ultrafiltration in hemodialysis: Associations with reduced mortality in the DOPPS,” Kidney International, Vol. 69 No. 7, pp. 1222–1228, April 2006.
[8]	United States Renal Data System 2008 Annual Report.
[9]	J. D. Sullivan, “Making peritoneal dialysis and home hemodialysis more economically viable,” Nephrology News and Issues and Issues, pp. 54–58, July 2006.
[10]	United States Renal Data System Annual Data Report, Chapter 2, Incidence and Prevalence, 2008, http://www. USRDS.org.
[11]	F. Coronel, et al., “Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis,” Journal of Nephrology, Vol. 16, No. 5, pp. 697–702, September–October, 2006.
[12]	J. J. Snyder, R. N. Foley, D. T. Gilberston, E. F. Vonesh, and A. J. Collins, “Hemoglobin levels and erythropoietin doses in hemodialysis and peritoneal dialysis patients in the United States,” Journal of the American Society of Nephrology, Vol. 15, No. 1, pp. 174–179, 2004.
[13]	United States Renal Data System Annual Data Report, Section K, The Economic Costs of ESRD, pp. 292, 2008, http://www.USRDS.org.
[14]	1999 HCFA statistics. Baltimore, Health Care Financing Administration, April 2000, (HCFA publication no. 03421).
[15]	Nephrology News and Issues, July 2009.
[16]	http://www.davita.com/dialysis/treatment/a/1867.
[17]	J. D. Sullivan, “Making peritoneal dialysis and home hemodialysis more economically viable,” Nephrology News and Issues, pp. 54–58, July 2006.
[18]	http://www.aakp.org/aakp-library/Fewer-Patients-Peritoneal-Dialysis/.
[19]	United States Renal Data System, 2008 Annual Report
[20]	J. Sullivan, “Bundling and its potential impact on dialysis service providers,” Nephrology News and Issues, October 2008.
[21]	J. D. Sullivan, “Bundling and its potential impact on dialysis service providers,” Nephrology News and Issues, October 2008.