Economic evaluation of hemodialysis: Implications for technology assessment in Greece

Objectives: Hemodialysis is a well-established treatment for 74 percent of end-stage renal disease (ESRD) patients in Greece. The purpose of this study is to provide an estimate of the direct cost of dialysis in a public hospital setting and an estimate of the loss of production for ESRD patients. The results will be useful for public health facility planning purposes. Methods: A socioeconomic prevalence-based analysis was performed using micro-economic evaluation of health-care resources consumed to provide hemodialysis for ESRD patients in 2000. Lost productivity costs due to illness were estimated for the patient and family using the human capital approach and the friction method. Indirect morbidity costs due to absence from work and long-term were estimated, as well as mortality costs. Mean gross income was used for both patient and family. Results: Total health-sector cost for hemodialysis in Greece exceeds Euro 171 million, or Euro 182 per session and Euro 229 per inpatient day. There were 2,046 years lost due to mortality, and the potential productivity cost was estimated at Euro 9.9 million, according to the human capital approach, and Euro 303.000, according to the friction method. Total morbidity cost due to absence from work and early retirement was estimated at more than Euro 273 million, according to the human capital approach, and Euro 12.5, according to the friction method. Conclusions: Providing hemodialysis care for 0.05 percent of the population suffering from ESRD absorbs approximately 2 percent of total health expenditure in Greece. In addition to the cost for the National Health System, production loss due to mortality and morbidity from the disease are also considerable. Promoting alternative technologies such as organ transplantation and home dialysis as well as improving hemodialysis efficiency through satellite units are strategies that may prove more cost-effective and psychologically advantageous for the patients.