NURS6050, Section 2B, Policy & Advocacy for Population Health
October 7, 2012
End-Stage Renal Disease Economics
End Stage Renal Disease (ESRD) is a costly, time consuming, non-curable medical condition. Caused by kidney failure resulting from co-morbidities such as diabetes and hypertension. 26 million people in the United States are currently living with ESRD and increasing amount of people are at risk for developing the disease (Sullivan, 2009). ESRD will ultimately be fatal if not treated with a kidney transplant or dialysis treatment (Sullivan, 2009). Therefore, the inevitable question arises of how patients, doctors, and government-sponsored programs are keeping up with the increasing amount of patients being diagnosed with ESRD and the cost effectiveness of the treatment modalities. The article, End Stage Renal Disease Economics and the Balance of Treatment Modalities by John Sullivan addresses this question and summarizes the economics, business, and cost effectiveness of multiple treatment options. With an increasing number of individuals at risk for developing kidney failure, it is imperative patients understand their treatment options and cost associated with such.
Three treatment options are available for ESRD. According to Sullivan (2009), kidney transplantation is, “The most cost effective therapy.” However, with the number of patients needing kidney transplants on the rise, and the number of available kidneys on the decline, this option is not available for everyone. For those who cannot receive a kidney transplant, two other options are available. The first option, Hemodialysis (HD), utilizes and artificial filter from a machine to rid the toxins kidneys rid of naturally. This treatment is time consuming and requires a visit to a HD clinic three times a week. In addition, a surgical procedure is needed to create a vascular access for treatment. The second option, Peritoneal Dialysis (PD), utilizes the patient’s own peritoneal cavity as a filter to rid the body of toxins. Dialysate, fluid instilled in the peritoneal cavity, is instilled via gravity flow into the abdomen. The fluid creates an osmotic pressure gradient and toxins transfer through the peritoneal cavity and are disposed off through an outgoing port in the abdomen. This treatment does not have to be performed at a specialty clinic, however needs to be completed seven days a week. While both treatments satisfy filtering out toxins, Hemodialysis requires the purchase of additional pharmaceutical drugs, which increases the cost associated with HD treatment.
In the 1970’s, the Federal Government devised a program through Medicare, utilizing tax dollars to pay for all treatments associated with dialysis treatment. According to Sullivan (2009), “For both therapies, reimbursement is currently based on a basic treatment with additional payments for ancillary drugs and testing” (Sullivan, 2009). Since the payment structure for HD and PD are described as being one in the same, the difference remains the additional costs of drugs associated with patients receiving HD over patients receiving PD. PD is portrayed as being the better cost effective option because PD patients are, “Typically healthier than their HD counterparts and often don’t require additional drugs to maintain a better quality of life” (Sullivan, 2009).
The Federal Government’s implementation of the ESRD program was an attempt to evaluate the effectiveness of the possible incorporation of universal healthcare to US citizens. With costs consuming 6% of Medicare’s budget for patients within the 1% population living with ESRD, “Exploding costs have placed more and more of an economic burden on Medicare (Sullivan, 2009). In addition, this program’s effectiveness was illustrated as an “economic burden with high mortality rates (Sullivan, 2009). The article…