Exploring kidney dialysis costs in the United States: a scoping review

Abstract

Aims

The increasing prevalence of end-stage renal disease (ESRD) in the United States (US) represents a considerable economic burden due to the high cost of dialysis treatment. This review examines data from real-world studies to identify cost drivers and explore areas where dialysis costs could be reduced.

Methods

We identified and synthesized evidence published from 2016-2023 reporting direct dialysis costs in adult US patients from a comprehensive literature search of MEDLINE, Embase, and grey literature sources (e.g. US Renal Data System reports).

Results

Most identified data related to Medicare expenditures. Overall Medicare spending in 2020 was $29B for hemodialysis and $2.8B for peritoneal dialysis (PD). Dialysis costs accounted for almost 80% of total Medicare expenditures on ESRD beneficiaries. Private insurance payers consistently pay more for dialysis; for example, per person per month spending by private insurers on outpatient dialysis was estimated at $10,149 compared with Medicare spending of $3,364. Dialysis costs were higher in specific high-risk patient groups (e.g. type 2 diabetes, hepatitis C). Spending on hemodialysis was higher than on PD, but the gap in spending between PD and hemodialysis is closing. Vascular access costs accounted for a substantial proportion of dialysis costs.

Limitations

Insufficient detail in the identified studies, especially related to outpatient costs, limits opportunities to identify key drivers. Differences between the studies in methods of measuring dialysis costs make generalization of these results difficult.

Conclusions

These findings indicate that prevention of or delay in progression to ESRD could have considerable cost savings for Medicare and private payers, particularly in patients with high-risk conditions such as type 2 diabetes. More efficient use of resources is needed, including low-cost medication, to improve clinical outcomes and lower overall costs, especially in high-risk groups. Widening access to PD where it is safe and appropriate may help to reduce dialysis costs.

PLAIN LANGUAGE SUMMARY

Previous papers have studied the cost of treating patients who need dialysis for kidney failure. We reviewed these costs and looked for patterns. Dialysis was the most expensive part of treatment for people with kidney disease who have Medicare. Dialysis with private insurance was much more expensive than with Medicare. People with diabetes experienced higher costs of dialysis than those without diabetes. Dialysis in a hospital costs more than dialysis at home. There are opportunities to reduce the cost of dialysis that should be explored further, such as more use of low-cost medication that can prevent the worsening of kidney disease and reduce the need for dialysis.

Keywords:

• Dialysis
• costs
• hemodialysis
• peritoneal dialysis
• end-stage renal disease
• united states
• narrative review

JEL Classification Codes:

• I13
• I1
• I
• H51
• H5
• H
• I10
• I11

Transparency

Declaration of financial/other relationships

KK, BD, and FS report funding from Bayer to their employer, Cencora, to inform this research. RRS reports employment, support for attending meetings and/or travel, and stock or stock options from Bayer. YD reports employment, support for attending meetings and/or travel, and stock or stock options from Bayer. SK reports employment and support for attending meetings and/or travel from Bayer.

Author contributions

Conception and design: YD, RS, BD, SK, FS, and KK. Literature searches, assessment of eligibility of studies for inclusion, extracted data: FS and KK. Data interpretation, drafting, revision, and final approval of manuscript: all authors. All authors agree to be accountable for all aspects of the work, which includes ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgements

The authors would like to thank Lori Justice and Kylie Matthews for their assistance in preparing early drafts of this manuscript.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was funded by Bayer. Beyond the named authors employed by Bayer, the funding source was not involved in the design of the study; collection, analysis and interpretation of data; writing the manuscript, or the decision to submit the manuscript for publication.