Dissertation committee:
Βασίλειος Σμυρνιώτης, Καθηγητής, Ιατρική, ΕΚΠΑ
Νικόλαος Αρκαδόπουλος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Ειρήνη Γράψα, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Αναστάστιος Μαχαίρας, Καθηγητής, Ιατρική, ΕΚΠΑ
Δημήτριος Μπούμπας, Καθηγητής, Ιατρική, ΕΚΠΑ
Ανδρέας Λάζαρης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Παντελεήμων Βασιλείου, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Chronic renal disease and in particular her final stage, is a major health problem in developed societies, with a constantly increasing number of patients. In 2008 there were worldwide approximately 1,75 million patients who received any type of treatment for renal malfunction. Of these, almost 89% (1,550,000 patients) undergoing hemodialysis (HD) and about 11% (197,000 patients) undergoing peritoneal dialysis (PD). According to recent data, Greece is in the eighth position in the world ranking scale of patients undergoing renal replacement therapy mode, proportionally taking in consideration the actual population. The integration into a unit for 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.
Purpose: The purpose of this thesis is the study and measurement of the cost of replacement therapy for people with end stage renal failure, which is of particular interest because of our country's contemporary social, political and specific economic situation. Specifically, we aim to calculate the cost of dialysis (peritoneal and hemodialysis) in Greece compared with other countries, taking into account the fragile reality as reflected in the health sector in the Greek area.
Method: We recorded the characteristics and the total cost of dialysis treatment for 100 patients integrated in Peritoneal Dialysis and 2,586 patients integrated in Artificial Kidney, in both cases using a public hospital or a private clinic (in Greece used only by Artificial Kidney patients). The total cost includes the procedure clearance, all consumables used for this procedure, medications, laboratory and non-necessary medical examinations, feeding and transport cost allowance (only for patients of Artificial Kidney), which in case of public sector is covered by the state, and in private clinical is fully covered by the patient insurance. Additionally included are the salaries of medical and non-personnel which requires a unit to operate, the equipment maintenance and potentially acquisition of new (through depreciation costs), the maintenance cost of the facilities, the cost of medical supplies and the one of support services.
Results: Average age for patients following Peritoneal Dialysis is 64,5±16,8 years, while for those using Artificial kidney is 68,7±14,1 years (p<0,001). Similar to Greece appeared to be the average age for Australia and New Zealand patients that is calculated to be 62 years, while youngest patients are in Turkey, where the mean age is 46±14,3 years. Regarding Peritoneal Dialysis, in countries outside the EU, like Turkey, Taiwan, Brazil, S. Korea, Switcherland, USA and China, the average age is calculated to be from a minimum of 48±16,8 years (Brazil) to 58,1±14 years (S. Korea). Diabetes appears to be the most common cause of ESRD with 32% for patients that are using Artificial Kidney, while in several countries like Turkey (35,2%), Brazil (36%), Mexico (61%), S. Korea (48,2%), Australia & New Zealand (34,9%), diabetes is considered to be the main cause of ESRD also people that are using Peritoneal Dialysis. In Greece, as main cause of ESRD has been recorded the “unknown” with a total percentage 33,02%. Similar situation are facing the patients of Spain, Italy, Hungary, Poland, Portugal and Turkey. From all patients recorded at Peritoneal Dialysis, almost 35% are active workers, while for Artificial kidney this percentage is only 7,2% (p<0,001). 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). 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 is 3.254.3±37,5€. This cost is fully covered by the patient insurance. At the same time, there is a monthly operating cost that burden the state and in the case of a PD public hospital goes at 11.694,4€, and a similar monthly cost for a HD public hospital that amounts at 63.449,75€. While we refer to the private sector in HD, this monthly costs that has to be paid by the patient insurance amounts at 181.155€
Conclusion: According to the Greek Authority of Coordination and Control of the final stage of chronic renal failure (YSE), patients with end-stage renal disease in Greece continue to increase in absolute number. There is a significant economic gap cost among patients who use Peritoneal Dialysis versus those using Artificial Kidney, as the cost of running a Peritoneal Dialysis Unit is very low compared with that of the Dialysis Unit. Patients who are using Peritoneal Dialysis appears to be in better shape (health status) compared to the ones using Artificial Kidney. 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 Dialysis unit in their vast majority are retired or unemployed, as described by the actual percentage that is touching 92,8%
