New Zealand residents are entitled to a number of government paid benefits, dependent on factors such as existing chronic disease, disability, unemployment, and annual household income. Additional costs for home dialysis patients, such as transport to clinic appointments, pharmacy costs, and home dialysis set‐up costs are not routinely covered or reimbursed however, transport costs for hospital dialysis patients are covered (Supporting Information Table S1). Patients treated with dialysis at home are not entitled to reimbursement for personal costs (such as electricity, water or transport), although some individual dialysis units provide patients with an annual lump sum payment toward household utility‐related expenses. In New Zealand, patients with ESKD receive all secondary care medical treatment including dialysis and kidney transplantation via a tax‐funded public health system. The aim of our study was to describe the perspectives of patients and families on how economic factors such as costs, benefits, and access to resources, influence decisions about dialysis treatment modality. 4 Home dialysis is offered to patients with a broad range of socioeconomic backgrounds and is considered a central treatment option for patients who are approaching dialysis. In New Zealand, home dialysis rates are among the highest in the world with 52% of adults currently receiving home‐based therapy. The extent to which patient contribution influences choice of dialysis modality has not been fully explored. 10 In contrast, there is less known about microlevel initiatives, and in particular those that deal with patient factors including loss of employment and out‐of‐pocket costs. There is some limited evidence that macrolevel initiatives can influence dialysis practice patterns. 7, 8, 9Īcross the globe, various healthcare reimbursement schemes have been implemented to improve dialysis care and at the same time curtail rising treatment expenditure. 4 One strategy to reduce the cost of dialysis is to increase the proportion of people treated with home‐based peritoneal or hemodialysis 5, 6 given the generally good outcomes and lower cost of these modalities. The number of people treated with dialysis in the United States (US) now exceeds 449,000 with the vast majority (91%) being treated with hospital or facility‐based hemodialysis. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers.Īs the financial burden of treatment of end‐stage kidney disease (ESKD) on global health systems increases, 1, 2, 3 policymakers are challenged to provide widely available, affordable, and quality dialysis. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason.ĭiscussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable they could not afford the additional treatment costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment (ii) the need for personal subsidization of home dialysis expenses and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Interview transcripts were analyzed thematically.įindings 43 patients and 9 caregivers (total n = 52) participated. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services.
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