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Rizzolo K, Shen JI. Barriers to home dialysis and kidney transplantation for socially disadvantaged individuals. Curr Opin Nephrol Hypertens 2024; 33:26-33. [PMID: 38014998 DOI: 10.1097/mnh.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW People with kidney disease facing social disadvantage have multiple barriers to quality kidney care. The aim of this review is to summarize the patient, clinician, and system wide factors that impact access to quality kidney care and discuss potential solutions to improve outcomes for socially disadvantaged people with kidney disease. RECENT FINDINGS Patient level factors such as poverty, insurance, and employment affect access to care, and low health literacy and kidney disease awareness can affect engagement with care. Clinician level factors include lack of early nephrology referral, limited education of clinicians in home dialysis and transplantation, and poor patient-physician communication. System-level factors such as lack of predialysis care and adequate health insurance can affect timely access to care. Neighborhood level socioeconomic factors, and lack of inclusion of these factors into public policy payment models, can affect ability to access care. Moreover, the effects of structural racism and discrimination nay negatively affect the kidney care experience for racially and ethnically minoritized individuals. SUMMARY Patient, clinician, and system level factors affect access to and engagement in quality kidney care. Multilevel solutions are critical to achieving equitable care for all affected by kidney disease.
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Affiliation(s)
- Katherine Rizzolo
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology
| | - Jenny I Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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Stewart F, Kistler K, Du Y, Singh RR, Dean BB, Kong SX. Exploring kidney dialysis costs in the United States: a scoping review. J Med Econ 2024; 27:618-625. [PMID: 38605648 DOI: 10.1080/13696998.2024.2342210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 04/13/2024]
Abstract
AIMS The increasing prevalence of end-stage renal disease (ESRD) in the United States (US) represents a considerable economic burden due to the high cost of dialysis treatment. This review examines data from real-world studies to identify cost drivers and explore areas where dialysis costs could be reduced. METHODS We identified and synthesized evidence published from 2016-2023 reporting direct dialysis costs in adult US patients from a comprehensive literature search of MEDLINE, Embase, and grey literature sources (e.g. US Renal Data System reports). RESULTS Most identified data related to Medicare expenditures. Overall Medicare spending in 2020 was $29B for hemodialysis and $2.8B for peritoneal dialysis (PD). Dialysis costs accounted for almost 80% of total Medicare expenditures on ESRD beneficiaries. Private insurance payers consistently pay more for dialysis; for example, per person per month spending by private insurers on outpatient dialysis was estimated at $10,149 compared with Medicare spending of $3,364. Dialysis costs were higher in specific high-risk patient groups (e.g. type 2 diabetes, hepatitis C). Spending on hemodialysis was higher than on PD, but the gap in spending between PD and hemodialysis is closing. Vascular access costs accounted for a substantial proportion of dialysis costs. LIMITATIONS Insufficient detail in the identified studies, especially related to outpatient costs, limits opportunities to identify key drivers. Differences between the studies in methods of measuring dialysis costs make generalization of these results difficult. CONCLUSIONS These findings indicate that prevention of or delay in progression to ESRD could have considerable cost savings for Medicare and private payers, particularly in patients with high-risk conditions such as type 2 diabetes. More efficient use of resources is needed, including low-cost medication, to improve clinical outcomes and lower overall costs, especially in high-risk groups. Widening access to PD where it is safe and appropriate may help to reduce dialysis costs.
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Affiliation(s)
- Fiona Stewart
- Cencora, Biopharma Services, Conshohocken, Pennsylvania, USA
| | - Kristin Kistler
- Cencora, Biopharma Services, Conshohocken, Pennsylvania, USA
| | - Yuxian Du
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | - Rakesh R Singh
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | - Bonnie B Dean
- Cencora, Biopharma Services, Conshohocken, Pennsylvania, USA
| | - Sheldon X Kong
- Cencora, Biopharma Services, Conshohocken, Pennsylvania, USA
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Rostoker G, Issad B. Financial Barriers to the Optimal Use of Peritoneal Dialysis in France and Europe, as in the United States. J Am Soc Nephrol 2022; 33:2125-2126. [PMID: 36041789 PMCID: PMC9678025 DOI: 10.1681/asn.2022070839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Guy Rostoker
- Department of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay Santé, Quincy-sous-Sénart, France
- Collège de Médecine des Hôpitaux de Paris, Paris, France
| | - Belkacem Issad
- Peritoneal Dialysis Centre, Nephrology Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Réseau Epidémiologique et Information en Néphrologie, Agence de la Biomédecine, Saint-Denis La Plaine, France
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Cahill Z, Conway PT, Lim MD. Reducing the Risks of Home Dialysis Innovation and Uptake: The Case for Human-Centered Product Design. Clin J Am Soc Nephrol 2022; 17:1688-1690. [PMID: 35961785 PMCID: PMC9718037 DOI: 10.2215/cjn.05100422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Mark D. Lim
- American Society of Nephrology, Washington, DC
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Tummalapalli SL, Navathe AS, Ibrahim SA. Early Findings From Medicare's End-Stage Renal Disease Treatment Choices Model. JAMA HEALTH FORUM 2022; 3:e223500. [PMID: 36206008 PMCID: PMC10133989 DOI: 10.1001/jamahealthforum.2022.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences and Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Amol S Navathe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Said A Ibrahim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Associate Editor, JAMA Health Forum
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Brown EA, Ekstrand A, Gallieni M, Gorrín MR, Gudmundsdottir H, Guedes AM, Heidempergher M, Kitsche B, Lobbedez T, Lundström UH, McCarthy K, Mellotte GJ, Moranne O, Petras D, Povlsen JV, Punzalan S, Wiesholzer M. Availability of assisted peritoneal dialysis in Europe: call for increased and equal access. Nephrol Dial Transplant 2022; 37:2080-2089. [PMID: 35671088 DOI: 10.1093/ndt/gfac193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. METHODS Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow, and their top 3 priorities. RESULTS Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD with all respondents mentioning need for nephrology team education and/or patient education and involvement in dialysis modality decision making. CONCLUSION AND CALL TO ACTION Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and for all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policy makers and healthcare providers to develop and support assistance for PD.
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Affiliation(s)
- Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Centre, London, UK
| | - Agneta Ekstrand
- Helsinki University Hospital, Abdomen Center, Nephrology, Helsinki, Finland
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Maite Rivera Gorrín
- Hospital Ramón y Cajal, Servicio de Nefrología. UAH. IRyCis. Carretera de Colmenar km 9, 100 28034 Madrid, Spain
| | | | - Anabela Malho Guedes
- Serviço de Nefrologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Benno Kitsche
- Kuratorium für Dialyse und Nierentransplantation e.V., Cologne.,NADia - Netzwerk assistierte Dialyse, Berlin, Germany
| | - Thierry Lobbedez
- Néphrologie, CHU CAEN, Avenue de la Côte de Nacre, CAEN CEDEX 9, France
| | - Ulrika Hahn Lundström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kate McCarthy
- Baxter Healthcare Ltd, Wallingford, Compton, Newbury, UK
| | - George J Mellotte
- Trinity Health Kidney Centre, Tallaght University Hospital, Tallaght, Dublin NROA
| | - Olivier Moranne
- Department Nephrology-Dialysis-Apheresis, CHU Caremeau Nimes, France
| | - Dimitrios Petras
- Department of Nephrology, General Hospital 'Hippokration', Athens, Greece
| | - Johan V Povlsen
- Dept. Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Punzalan
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Centre, London, UK
| | - Martin Wiesholzer
- Clinical Department for Internal Medicine1, University Hospital St.Poelten, Austria, Karl Landsteiner University of Health Sciences
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