Regular dialysis costs in a public hospital: Myths and realities

In this study regular dialysis treatment costs during 1998 and 1999 in a pu blic hospital, which is responsible for a population of 178,000 has been an alysed. Hemodialysis (HD) and peritoneal dialysis (PD) costs have been diff erentiated and compared with those of external providers. The best technica l and productive efficiency of both treatments have been estimated by analy zing the much less than treatment cost/human resources of the community uti lized much greater than relationship. The HD treatment costs per patient per year were 20,343 and 18,871 euros in 1988 and 1,999, respectively, lower than the costs reported in other studi es. In 1999 these costs were similar to those of external providers and low er than the PD treatment costs (23,295 euros). HD retains its advantage eve n after costs of erythropoietin, hospital admissions and transport are incl uded. In the hospital studied, the best technical efficiency in HD would be reach ed with 64 patients on treatment (17,851 euros per patient per year) and in PD with 48 patients (21,167 euros per patient per year). If we take into a ccount our population characteristics and consider a patient distribution o f 70% on HD and 30% on PD, the best productive efficiency would be reached with 56 patients on HD (17,916 euros per patient per year) and 24 patients on PD (21,813 euros per patient per year). HD confers the greatest economic and social benefits on the population supplied by the hospital since it pr ovides the community with more jobs than PD in relation to treatment costs while the two yield the same clinical results. In conclusion, HD in a public hospital, at least in our environment, may be efficient and competitive with HD from external providers and it may be mo re efficient and provide a bigger economic and social profit for the popula tion serviced by the hospital than PD, at least while the current supply sy stems for this treatment in our country are maintained.