Cost analysis of renal replacement therapies in Finland

Background: Costs for treating patients with end-stage renal disease (ESRD) have grown noticeably. However, most of the cost estimates to date have taken the perspective of the payers. Hence, direct costs of treating ESRD are not accurately known. Methods: Files of all adult patients with ESRD who entered dialysis therapy between January 1, 1991, and December 31,1996, were studied retrospectively, and all use of health care resources and services was recorded. Follow-up continued until December 31, 1996. Results: Two hundred fourteen patients fulfilled the study criteria, 138 patients started with in-center hemodialysis (HD) therapy, and 76 patients started with continuous ambulatory peritoneal dialysis (CAPD) therapy. Patients were followed up until death (72 patients) or treatment modality changed for more than 1 month. Fifty-five patients received a cadaveric transplant, and after transplantation (TX), they were examined as a separate group of TX patients. Direct health care costs for the first 6 months in the HD, CAPD, and TX groups were US $32,566, $25,504, and $38,265, and for the next 6 months, $26,272, $24,218, and $7,420, respectively. During subsequent years, annual costs were US $54,140 and $54,490 in the HD group, $45,262 and $49,299 in the CAPD group, and $11,446 and $9,989 in the TX group. Regression analyses showed 4 variables significantly associated with greater daily costs in dialysis patients: age, ischemic heart disease, nonprimary renal disease, and HD treatment. Conclusion: Compared with HD, CAPD may be associated with lower costs, yet the absolute difference is not striking. After the TX procedure is performed once, annual costs decline remarkably, and cadaveric TX is less costly than both dialysis modalities. (C) 2003 by the National Kidney Foundation, Inc.