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The social cost of chronic kidney disease in Italy.

ABSTRACT: This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expenses of low-protein special foods, travel, and formal and informal care. Patients' and caregivers' losses of productivity have been estimated as indirect costs using the human capital approach. Costs have been expressed in Euros (2016). Totals of 279 patients in stage 4 and 205 patients in stage 5 have been enrolled. The estimated mean annual social cost of a patient with CKD were €7422 (±€6255) for stage 4 and €8971 (±€6503) for stage 5 (p < 0.05). Direct medical costs were higher in stage 5 as compared to stage 4; direct non-medical costs and indirect costs accounted, respectively, for 41 and 5 % of the total social cost of CKD stage 4 and for 33 and 9 % of CKD stage 5. In Italy, the overall annual social cost of CKD was €1,809,552,398 representing 0.11 % of the Gross Domestic Product. Direct non-medical costs and indirect costs were weighted on the social cost of CKD almost as much as the direct medical cost. Patients, their families and the productivity system sustain the burden of the disease almost as much as the healthcare system.

SUBMITTER: Turchetti G

PROVIDER: S-EPMC5533856 | biostudies-other | 2017 Sep

REPOSITORIES: biostudies-other

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The social cost of chronic kidney disease in Italy.

Turchetti Giuseppe G Bellelli S S Amato M M Bianchi S S Conti P P Cupisti A A Panichi V V Rosati A A Pizzarelli F F

The European journal of health economics : HEPAC : health economics in prevention and care 20161003 7

This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expe ...[more]

PMID: 27699568

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Project description:Background:Health systems are under pressure to deliver more effective care without expansion of resources. This is particularly pertinent to diseases like chronic kidney disease (CKD) that are exacting substantial financial burden to many health systems. The aim of this study is to systematically review the Cost Utility Analysis (CUA) evidence generated across interventions for CKD patients undergoing kidney transplant (KT). Methods:A systemic review of CUA on the interventions for CKD patients undergoing KT was carried out using a search of the MEDLINE, CINAHL, EMBASE, PsycINFO and NHS-EED. The CHEERS checklist was used as a set of good practice criteria in determining the reporting quality of the economic evaluation. Quality of the data used to inform model parameters was determined using the modified hierarchies of data sources. Results:A total of 330 articles identified, 16 met the inclusion criteria. Almost all (n?=?15) the studies were from high income countries. Out of the 24 characteristics assessed in the CHEERS checklist, more than 80% of the selected studies reported 14 of the characteristics. Reporting of the CUA were characterized by lack of transparency of model assumptions, narrow economic perspective and incomplete assessment of the effect of uncertainty in the model parameters on the results. The data used for the economic model were satisfactory quality. The authors of 13 studies reported the intervention as cost saving and improving quality of life, whereas three studies were cost increasing and improving quality of life. In addition to the baseline analysis, sensitivity analysis was performed in all the evaluations except one. Transplanting certain high-risk donor kidneys (high risk of HIV and Hepatitis-C infected kidneys, HLA mismatched kidneys, high Kidney Donor Profile Index) and a payment to living donors, were found to be cost-effective. Conclusions:The quality of economic evaluations reviewed in this paper were assessed to be satisfactory. Implementation of these strategies will significantly impact current systems of KT and require a systematic implementation plan and coordinated efforts from relevant stakeholders.

Project description:BackgroundChronic kidney disease (CKD) is associated with multiple comorbidities, hospitalizations and mortality. In older adults, social isolation and poor mobility contribute to these outcomes. We tested the hypothesis that a glomerular filtration rate (GFR) <45 mL/min/1.73 m2 (CKD Stages 3b-5) is associated with social isolation and that mobility limitation is a key driver of social isolation in patients with CKD.MethodsData from 9119 participants, ages 57-107 years, from the 2016 wave of the Health and Retirement Study's Venous Blood Study were used for this cross-sectional analysis. Kidney function measured by estimated GFR (eGFR) was the predictor and patients were classified as CKD Stages 3b-5 or non-CKD Stages 3b-5 (eGFR ≤45 or >45 mL/min/1.73 m2). The outcomes tested were mobility limitation assessed by self-report and social contact and participation measures assessed by the Psychosocial Life Questionnaire. The associations among kidney function, mobility and social isolation were examined with logistic and ordinary least squares regression, adjusted for covariates and testing for interaction with gender.ResultsParticipants with CKD Stages 3b-5 (N = 999) compared with non-CKD Stages 3b-5 were older (74.9 versus 68.2 years, P < 0.001) and fewer were female (15% versus 58%, P < 0.001). CKD Stages 3b-5 were associated with higher odds of difficulty walking several blocks [odds ratio 1.44 (95% confidence interval 1.16-1.78)]. Participants with CKD Stages 3b-5 had reduced social contact and social participation (B = -0.23, P < 0.05; B = -0.62, P < 0.05, respectively). Women with CKD Stages 3b-5 were 2.7 times more likely to report difficulty walking several blocks than men with CKD Stages 3b-5, but social isolation in CKD Stages 3b-5 did not vary by gender. In CKD Stages 3b-5 patients, mobility limitation was a risk factor for reduced social contact and participation but did not explain the poor social contact and participation.ConclusionCKD Stages 3b-5 was associated with both mobility limitation and social isolation in a population-based study of older adults. In contrast to older adults without CKD Stages 3b-5, mobility limitation did not explain the lack of social contact and poor social participation, suggesting other factors are more important.

Project description:BackgroundChronic kidney disease (CKD) is a health problem due to its increasing prevalence and imposes a significant economic burden on the health system. This study aimed to analyze the cost-benefit of kidney transplantation through the valuation of patients with ESRD for a kidney transplant and its costs to help decide this regard.Material and methodsThis study was a descriptive-analytical and cross-sectional economic evaluation study of health interventions performed in Imam Khomeini Hospital in Urmia from the patient's perspective. The records of kidney recipients were used to calculate the direct costs of kidney transplantation based on the government tariff rate in 2021. The willingness to pay for kidney transplantation (benefit) was measured through a questionnaire and with a contingent valuation method from 266 samples of patients with ESRD. The questionnaire designed by the researchers had four scenarios with different chances for kidney transplant success. Validation and test-retest methods were used to check the validity and reliability of the questionnaire. Stata software was used to estimate the regression of the factors affecting the willingness to pay and the kidney transplant demand function.ResultsThe average cost of a kidney transplant was $877.4. The average willingness to pay for a kidney transplant for four scenarios was estimated at $4733. The mean cost-benefit ratio (BCR) and net present value (NPV) for the four kidney transplant scenarios were 5.39 and $3855. The variables of employment status, awareness of kidney function, number of years with ESRD, insurance coverage, and patients' income significantly affected their willingness to pay. However, the effect of other variables was not significant. The absolute value of price elasticity of kidney transplant demand was also equal to 2.13.ConclusionAccording to the cost-benefit analysis indexes, the study results showed that a kidney transplant has a net positive benefit for all levels of its probability of success, so the willingness to pay or valuation of patients is about five times the cost of a kidney transplant. Also, the demand for kidney transplantation shows the high sensitivity of the demand for this service to the price. Therefore, preparations for kidney transplantation in patients with ESRD should be considered in situations where the price and cost of transplantation change. The results can help health policy-makers decide to allocate financial resources more efficiently.

Dataset Information

The social cost of chronic kidney disease in Italy.

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The social cost of chronic kidney disease in Italy.

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