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Titolo	Costs of dialysis?a regional population-based analysis
Autore	Andrea Icks1, Burkhard Haastert2, Afschin Gandjour3, Nadja Chernyak1, Wolfgang Rathmann1, Guido Giani1, Lars-Christian Rump4, Rudolf Trapp4 and Michael Koch4,5 1German Diabetes Center, Institute of Biometrics and Epidemiology, Düsseldorf, Germany, 2mediStatistica, Neuenrade, Germany, 3Pennington Biomedical Research Center/Louisiana State University, Baton Rouge, USA, 4Clinic of Nephrology, Heinrich Heine University, Düsseldorf, Germany and 5Center of Nephrology, Mettmann, Germany
Referenza	Nephrol Dial Transplant 2010; 25: 1647-1652
Contenuto	Background. Population-based estimates of costs of renal replacement therapy are scarce in the literature. The aim of our study was to calculate the costs of long-term dialysis in 2006 on the basis of patient-specific data from a well-defined population in a region in western Germany (n = 310 757). Methods. Cost estimation was performed from the perspective of the statutory health insurance. All dialysis patients from the study region (n = 344, 54% male, mean age (±SD) 69 ± 13 years, 42% diabetic) were assessed for the costs of the dialysis procedures, dialysis-related hospital admissions, outpatient contacts outside of our dialysis center, dialysis-related medication, patient transportation and related costs (e.g. reimbursement fees on the basis of the German diagnosis-related group system, price scales). We estimated the cumulative cost per patient year in 2006 (in Euros), along with the 10th and 90th percentiles and the 95% confidence intervals (CI) by using bootstrapping procedures. Results. The mean total dialysis-related cost in 2006 was 54 777 Euros (95% CI, 51 445-65 705) per patient year. The largest part of the costs (55%) was caused by the dialysis procedures, followed by the costs of medication (22%), hospitalization (14%) and transportation (8%). The total cost increased significantly with increasing age. No significant association was found between total cost and sex, dialysis strategy, end-stage renal disease duration and diabetes. Conclusions. We present for the first time a cost estimation of dialysis in Germany on the basis of patient-level data in a population-based sample. Except age, patient characteristics were not significantly associated with costs. The largest part of the costs was caused by the dialysis procedures themselves; however, other dialysis-specific health care utilization also strongly contributed to the total cost.
Data	13.12.2010

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