Chronic renal disease, and in particular its final stage, is a major health problem in developed societies with a constantly increasing number of patients. In 2008, there were approximately 1.75 million patients worldwide who received some type of renal dysfunction treatment: almost 89% out of these ones (1,550,000 patients) undergoing hemodialysis (HD) and about 11% (197,000 patients) undergoing peritoneal dialysis (PD) [1]. According to recent data, Greece is in the eighth position in the world ranking scale of patients undergoing renal replacement therapy, taking into account the actual population. The integration into a unit of kidney disease patients in Greece increases annually by 5-7%. This increase implies a cost burden on the social security and the state health budget.

Aim of this research is the study and measurement of the cost of kidney replacement therapy for people in the final stage of renal failure, being of particular interest due to our country’s contemporary social, political and specific economic situation. Specifically, our scope is to calculate and compare the cost of dialysis (peritoneal and hemodialysis) in Greece compared to other countries, taking into account the actual fragile reality as reflected in the health sector in the Greek area.

We have recorded the characteristics and the total dialysis treatment cost of 100 patients integrated into Peritoneal Dialysis and 2,586 patients integrated into Hemodialysis, patients that in both cases are using either a public hospital or a private clinic for their treatment (in Greece, only patients that follow Hemodialysis therapy use a private clinic). The total cost includes the clearance procedure, all consumables used during the treatment procedure, all necessary medications, laboratory and/or non-necessary medical examinations, feeding and/or transport cost allowance (only for patients of Hemodialysis). As far as the public sector is concerned, all the above are financially covered by the state, while private clinics expenses are fully covered by the patients’ health insurance. Additionally, we have included the salaries of medical and nonpersonnel required for the operation of a unit, the equipment maintenance and possible acquisition of new one (through depreciation costs), the maintenance cost of the facilities, the cost of medical supplies and the one of support services.

Average age of patients under Peritoneal Dialysis is 64.5 ± 16.8 years, while for those following Hemodialysis the average age is 68.7 ± 14.1 years (p<0.001) [2]. The average age of patients in Australia and New Zealand appears to be similar to the one in Greece, evaluated at 62 years, while the youngest patients are in Turkey where the mean age is 46 ± 14.3 years [3- 9]. Regarding Peritoneal Dialysis, in countries excluded from the EU, such as Turkey, Taiwan, Brazil, S. Korea, Switcherland, USA and China, the average age is calculated from a minimum of 48 ± 16.8 years (Brazil) to a maximum of 58.1 ± 14 years (S. Korea) [4,9-11]. Diabetes was recorded as the most common cause of ESRD for 32% of patients that are using Hemodialysis , while in several countries like Turkey (35.2%), Brazil (36%), Mexico (61%), S. Korea (48.2%), Australia & New Zealand (34.9%), diabetes is recorded to be the main cause of ESRD and this is also the case for people that are using Peritoneal Dialysis [5,8,10-12]. In Greece [2], the main cause of ESRD is “unknown”, with a total percentage of 33.02%. The patients of Spain, Italy, Hungary, Poland, Portugal and Turkey [5,8,10-12] are facing a similar situation. Out of all patients recorded at Peritoneal Dialysis, almost 35% are active workers, whereas, at Hemodialysis, this percentage is only 7.2% (p<0.001) [2]. The average distance for the PD patients is 41.6 ± 17.3 km, while for the HD patients is 16.1 ± 24.3 km (p<0.001) [2]. At the same time, the average monthly cost for PD patients has been calculated at 4.019,2 ± 1.126,3 €, while for the HD patients it is 3.254.3 ± 37,5 € [2]. This cost is fully covered by the patients insurance. At the same time, there is a monthly operating cost that burdens the state and in the case of a PD public hospital it amounts at 11.694,4 €, while the similar monthly cost for a HD public hospital amounts at 63.449,75 € [2]. While we refer to private sector in HD, this monthly costs that has to be paid by the patient insurance amounts at 181.155 € [2].

During recent past, several studies conducted at individual level (specific units) in Greece are referring exclusively to the calculation of the cost of hemodialysis by the Hemodialysis method. Unfortunately, there is no such study available for people using the Peritoneal Dialysis method.

Weisbrod, who, in a cost-benefit analysis of two programs for mental illness [13], one centered on hospital care and the other on social inclusion, observed that from the supportive point of view, initially the cost of the first program is significantly higher than the second. However, if the benefits of social integration and increased productivity of the patients are taken into account, then the second program seems to be the acre lighter [13]. When the relevant cost groups have been identified, the quantities of the individual components that make them, have been measured and their relative prices assigned. The units of measurement should be representative and describe a physical size such as the number of processes, the amount of time, space or equipment. For instance, in a patient monitoring program, some of the individual components of the analysis may be 100 doctors’ examinations and 10 weeks of nursing time. The same applies if we measure the costs incurred by patients and the productivity deficit (e.g. absence from work during hospitalization, transportation costs to and from the hospital, etc.).

As shown below, hemodialysis cost is mediocre. While in Greece [2] it seems to have risen steadily due to the evolution of technology, in fact, it has a declining course due to recent economic crisis. As observed in studies already recorded (citation to our article), our country is more economically compared to other countries like Belgium, the Netherlands, Germany and France [10,14-16]. In the international studies based on data from several units in Belgium, Germany, The Netherlands, England, and France, the annual cost per HD patient has been calculated at approximately €66,212, €44,575, €65,739, €29,322 and €53,758, respectively [7,15]. The same annual cost in Greece was estimated at €39,258.5, including all treatment-related costs. HD procedure seems to be more costeffective not only in Greece [2], but also in other countries, like England and the Netherlands.

While in Greece the formation of hemodialysis costs seems to have been on the upside, due to the evolution of technology, it is in fact declining due to the economic crisis. As it has been observed in studies already reported [2], in our country the hemodialysis expenses are lower than in countries such as Belgium, Holland, Germany and France. On the other hand, the cost is higher in countries like Denmark and Spain [4, 9-12].

Peritoneal dialysis cost reported from Belgium, Germany, The Netherlands, England, France, Denmark, Switzerland, and Spain [4,9-14] depended on the method (APD or CAPD). More specifically, the cost reported for Denmark was €16,178, Spain €25,826, England €41,989, France €63,463, Belgium €67,580, Germany €73,892, the Netherlands €77,254, and Switzerland €81,991. In our study [2], which included not only the dialysis procedure supplement, but also drugs, laboratory tests, and subsistence costs, the annual cost for each patient was €52,057.2. This means that the cost of PD in Greece is lower compared to other European countries. It is important that we notice that the operational cost of the dialysis unit has not been calculated yet in studies from other countries. An interesting finding is that a PD unit has a significantly lower operating cost than a HD unit (p<0.001). To estimate the real cost of treatment, the operating costs of the unit need to be included.

According to the Greek Authority of Coordination and Control of the final stage of chronic renal failure (YSE), patients with ESRD in Greece continue to increase in absolute number. There is a significant economic gap between the cost for patients using Peritoneal Dialysis versus those using Hemodialysis, as the cost of running a Peritoneal Unit is very lower, compared to the one of a Dialysis Unit. In addition, patients who are using Peritoneal Dialysis appear to be in better shape (health status) compared to those using Hemodialysis. This can be supported by the fact that a significant percentage of patients in Peritoneal Dialysis continue to work normally (35%) and are active members of their community. Instead, patients of hemo dialysis in their vast majority, are retired or unemployed, as described by their actual percentage approaching 92.8%.

References

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Article Information

Article Type: SHORT COMMUNICATION

Citation: Koukou MG, Smyrniotis VE, Arkadopoulos NF, Grapsa EI (2018) Financial Impact of Treatment for End Stage Renal Disease Patients in Greece under Economic Crisis. Int J Nephrol Kidney Fail 4(1): dx.doi.org/10.16966/2380-5498.152

Copyright: © 2018 Koukou MG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 20 Dec, 2017

Accepted date: 5 Jan, 2018

Published date: 11 Jan, 2018