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A call for harmonization of European kidney care : dialysis reimbursement and distribution of kidney replacement therapies

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Abstract
Background. We compare reimbursement for haemodialysis (HD) and peritoneal dialysis (PD) in European countries to assess the impact on government healthcare budgets. We discuss strategies to reduce costs by promoting sustainable dialysis and kidney transplantation. Methods. This was a cross-sectional survey among nephrologists conducted online July-December 2016. European countries were categorized by tertiles of gross domestic product per capita (GDP). Reimbursement data were matched to kidney replacement therapy (KRT) data. Results. The prevalence per million population of patients being treated with long-term dialysis was not significantly different across tertiles of GDP (P = 0.22). The percentage of PD increased with GDP across tertiles (4.9, 8.2, 13.4%; P < 0.001). The HD-to-PD reimbursement ratio was higher in countries with the highest tertile of GDP (0.7, 1.0 versus 1.7; P = 0.007). Home HD was mainly reimbursed in countries with the highest tertile of GDP (15, 15 versus 69%; P = 0.005). The percentage of public health expenditure for reimbursement of dialysis decreased across tertiles of GDP (3.3, 1.5, 0.7%; 1 3 < 0.001). Transplantation as a proportion of all KRT increased across tertiles of GDP (18.5, 39.5, 56.0%; P < 0.001). Conclusions. In Europe, dialysis has a disproportionately high impact on public health expenditure, especially in countries with a lower GDP. In these countries, the cost difference between PD and HD is smaller, and home dialysis and transplantation are less frequently provided than in countries with a higher GDP. In-depth evaluation and analysis of influential economic and political measures are needed to steer optimized reimbursement strategies for KRT.
Keywords
Nephrology, Transplantation, chronic haemodialysis, cost-saving, kidney transplantation, peritoneal dialysis, reimbursement for dialysis services, RENAL REPLACEMENT, DISEASE, COST, HEMODIALYSIS

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MLA
van der Tol, Arjan, et al. “A Call for Harmonization of European Kidney Care : Dialysis Reimbursement and Distribution of Kidney Replacement Therapies.” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 35, no. 6, 2020, pp. 979–86, doi:10.1093/ndt/gfaa035.
APA
van der Tol, A., Stel, V. S., Jager, K. J., Lameire, N., Morton, R. L., Van Biesen, W., … European Kidney Health Alliance (EKHA), [missing]. (2020). A call for harmonization of European kidney care : dialysis reimbursement and distribution of kidney replacement therapies. NEPHROLOGY DIALYSIS TRANSPLANTATION, 35(6), 979–986. https://doi.org/10.1093/ndt/gfaa035
Chicago author-date
Tol, Arjan van der, Vianda S Stel, Kitty J Jager, Norbert Lameire, Rachael L Morton, Wim Van Biesen, Raymond Vanholder, and [missing] European Kidney Health Alliance (EKHA). 2020. “A Call for Harmonization of European Kidney Care : Dialysis Reimbursement and Distribution of Kidney Replacement Therapies.” NEPHROLOGY DIALYSIS TRANSPLANTATION 35 (6): 979–86. https://doi.org/10.1093/ndt/gfaa035.
Chicago author-date (all authors)
van der Tol, Arjan, Vianda S Stel, Kitty J Jager, Norbert Lameire, Rachael L Morton, Wim Van Biesen, Raymond Vanholder, and [missing] European Kidney Health Alliance (EKHA). 2020. “A Call for Harmonization of European Kidney Care : Dialysis Reimbursement and Distribution of Kidney Replacement Therapies.” NEPHROLOGY DIALYSIS TRANSPLANTATION 35 (6): 979–986. doi:10.1093/ndt/gfaa035.
Vancouver
1.
van der Tol A, Stel VS, Jager KJ, Lameire N, Morton RL, Van Biesen W, et al. A call for harmonization of European kidney care : dialysis reimbursement and distribution of kidney replacement therapies. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2020;35(6):979–86.
IEEE
[1]
A. van der Tol et al., “A call for harmonization of European kidney care : dialysis reimbursement and distribution of kidney replacement therapies,” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 35, no. 6, pp. 979–986, 2020.
@article{8656045,
  abstract     = {Background. We compare reimbursement for haemodialysis (HD) and peritoneal dialysis (PD) in European countries to assess the impact on government healthcare budgets. We discuss strategies to reduce costs by promoting sustainable dialysis and kidney transplantation.

Methods. This was a cross-sectional survey among nephrologists conducted online July-December 2016. European countries were categorized by tertiles of gross domestic product per capita (GDP). Reimbursement data were matched to kidney replacement therapy (KRT) data.

Results. The prevalence per million population of patients being treated with long-term dialysis was not significantly different across tertiles of GDP (P = 0.22). The percentage of PD increased with GDP across tertiles (4.9, 8.2, 13.4%; P < 0.001). The HD-to-PD reimbursement ratio was higher in countries with the highest tertile of GDP (0.7, 1.0 versus 1.7; P = 0.007). Home HD was mainly reimbursed in countries with the highest tertile of GDP (15, 15 versus 69%; P = 0.005). The percentage of public health expenditure for reimbursement of dialysis decreased across tertiles of GDP (3.3, 1.5, 0.7%; 1 3 < 0.001). Transplantation as a proportion of all KRT increased across tertiles of GDP (18.5, 39.5, 56.0%; P < 0.001).

Conclusions. In Europe, dialysis has a disproportionately high impact on public health expenditure, especially in countries with a lower GDP. In these countries, the cost difference between PD and HD is smaller, and home dialysis and transplantation are less frequently provided than in countries with a higher GDP. In-depth evaluation and analysis of influential economic and political measures are needed to steer optimized reimbursement strategies for KRT.},
  author       = {van der Tol, Arjan and Stel, Vianda S and Jager, Kitty J and Lameire, Norbert and Morton, Rachael L and Van Biesen, Wim and Vanholder, Raymond and European Kidney Health Alliance (EKHA), [missing]},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {Nephrology,Transplantation,chronic haemodialysis,cost-saving,kidney transplantation,peritoneal dialysis,reimbursement for dialysis services,RENAL REPLACEMENT,DISEASE,COST,HEMODIALYSIS},
  language     = {eng},
  number       = {6},
  pages        = {979--986},
  title        = {A call for harmonization of European kidney care : dialysis reimbursement and distribution of kidney replacement therapies},
  url          = {http://dx.doi.org/10.1093/ndt/gfaa035},
  volume       = {35},
  year         = {2020},
}

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