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Cost of renal replacement : how to help as many as possible while keeping expenses reasonable?

Raymond Vanholder (UGent) , Norbert Lameire (UGent) , Lieven Annemans (UGent) and Wim Van Biesen (UGent)
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Abstract
The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.
Keywords
cost, quality of life, dialysis, peritoneal dialysis, kidney transplantation, socio-economics, CHRONIC KIDNEY-DISEASE, QUALITY-OF-LIFE, PRESUMED CONSENT LEGISLATION, NOCTURNAL HOME HEMODIALYSIS, PERITONEAL-DIALYSIS, UNITED-STATES, FREQUENT HEMODIALYSIS, ANEMIA MANAGEMENT, ELDERLY-PATIENTS, DIALYZER REUSE

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Chicago
Vanholder, Raymond, Norbert Lameire, Lieven Annemans, and Wim Van Biesen. 2016. “Cost of Renal Replacement : How to Help as Many as Possible While Keeping Expenses Reasonable?” Nephrology Dialysis Transplantation 31 (8): 1251–1261.
APA
Vanholder, R., Lameire, N., Annemans, L., & Van Biesen, W. (2016). Cost of renal replacement : how to help as many as possible while keeping expenses reasonable? NEPHROLOGY DIALYSIS TRANSPLANTATION, 31(8), 1251–1261.
Vancouver
1.
Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement : how to help as many as possible while keeping expenses reasonable? NEPHROLOGY DIALYSIS TRANSPLANTATION. 2016;31(8):1251–61.
MLA
Vanholder, Raymond, Norbert Lameire, Lieven Annemans, et al. “Cost of Renal Replacement : How to Help as Many as Possible While Keeping Expenses Reasonable?” NEPHROLOGY DIALYSIS TRANSPLANTATION 31.8 (2016): 1251–1261. Print.
@article{7092563,
  abstract     = {The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.},
  author       = {Vanholder, Raymond and Lameire, Norbert and Annemans, Lieven and Van Biesen, Wim},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {cost,quality of life,dialysis,peritoneal dialysis,kidney transplantation,socio-economics,CHRONIC KIDNEY-DISEASE,QUALITY-OF-LIFE,PRESUMED CONSENT LEGISLATION,NOCTURNAL HOME HEMODIALYSIS,PERITONEAL-DIALYSIS,UNITED-STATES,FREQUENT HEMODIALYSIS,ANEMIA MANAGEMENT,ELDERLY-PATIENTS,DIALYZER REUSE},
  language     = {eng},
  number       = {8},
  pages        = {1251--1261},
  title        = {Cost of renal replacement : how to help as many as possible while keeping expenses reasonable?},
  url          = {http://dx.doi.org/10.1093/ndt/gfv233},
  volume       = {31},
  year         = {2016},
}

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