The effect of the expenditure increase in the morbidity and the mortality of patients with end stage renal disease: the USA case.

The worldwide incidence of kidney failure is on the rise and treatment is costly. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of alternative dialysis modalities such as haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. Modality selection is also influenced by employment status, with an association between being employed and PD as the modality choice.In the United States, there were 101,688 incident HD patients and 6,506 incident PD patients in 2007. Due to the fact that the worldwide incidence of kidney failure continues to rise placing USA in the second position right after Taiwan, the accumulated experience from USA could be used as a characteristic prototype for the analysis of the economics related with modality choices and their influence in the quality of life and life expectancy of end stage renal disease (ESRD) patients.In the present work we discuss the effect of the expenditure increase in the morbidity and the mortality of patients with end stage renal disease. Data coming from the USA case concerning the economic factors which play a vital role in the sequence of events that leads to the choice between different modalities such as HD and PD, will be used as a distinctive example in our study. The relationship between the modality used and employment status is investigated. The cost effectiveness of alternative modalities is reviewed. Examples of statistical models and simulation approaches, studying the increase of the life expectancy in terms of the quality adjusted life years (QALYs) and the incremental cost paid are also presented. Corresponding results originated from different regions of the world are also briefly shown.