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Titolo The role of economies of scale in the cost of dialysis across the world: a macroeconomic perspective
Autore Akash Nayak Karopadi1,2, Giacomo Mason1, Enrico Rettore3 and Claudio Ronco1,4 - 1International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy, 2Department of Economics and Department of Chemical Engineering, BITS Pilani, Pilani, India, 3Department of Statistical Sciences, University of Padova, Padova, Italy and 4Department of Nephrology, Dialysis, and Transplantation, San Bortolo Hospital, Vicenza, Italy
Referenza Nephrol Dial Transplant 2014; doi: 10.1093/ndt/gft528

Background. The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries.

Methods. From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several countrylevel indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country’s level of development, economies of scale and percentage of private health-care expenditure.

Results. The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant.

Conclusions. it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the

absence of a large enough market to make local production of PD equipment feasible in that country.

Data 11.02.2014
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