Social Return On Investment For Patient Treated By Continuous Ambulatory Peritoneal Dialysis: A Case Study In Ubon Ratchathani Province, Thailand

Figures & data

Table 1 Stakeholders Included And Exclude In The Stakeholder Analysis

Stakeholder	Included/Excluded?	Reason for Including/Excluding
NHSO	Included	The NHSO acted as an investor for CAPD project and required benefit return on investment.
CAPD service centers	Included	Provided treatment and information to CAPD patients with the budget allocation from NHSO.
CAPD patients	Included	CAPD patients were the primary stakeholder and expected to gain the most benefits from CAPD project.
Caregivers	Included	Caregiver was affected by the illness and the changes that have occurred from CAPD project.
Sub-district Health Promoting Hospital	Excluded	Provided health care in a community but relatively small activities with CAPD project.
Sub district Administrative Organization	Excluded	Provided health promotion to a community but relatively small activities with CAPD project.
Thailand Post	Excluded	Dialysate fluid direct delivery to CAPD patients’ houses every month but NHSO could use other company to deliver them.

Abbreviations: NHSO, The National Health Security Office; CAPD service center, Continuous Ambulatory Peritoneal Dialysis Service Center; CAPD patient, End-stage Renal Disease’s patient treated with Continuous Ambulatory Peritoneal Dialysis modality under Universal coverage scheme.

Table 2 Impact Map And The Investment Of CAPD Project In The Fiscal Year 2016

Stakeholders	Input	Value THB (USD)	Activities	Output	Outcomes (What Changes)
NHSO	Direct medical cost (n=191 cases) -unit cost for CAPD treatment at CAPD service center 3,000 THB (92.85 USD) per patients per month	4,086,746 (126,484)	CAPD project management	- increase access to CAPD treatment rate - increase survival rate after 12 months - Decrease peritonitis rate	CAPD patients had good quality of life, not being the burden of society and ready for KT in the future
	- Cost of Erythropoietin and injection administration Cost of Erythropoietin multiplied 4–8 doses per month multipliedinjection administration 200 THB (6.19 USD) per month multiplied number of CAPD patients	2,179,598 (67,458)
	- Dialysate fluid delivery to CAPD patients 128 THB (3.96 USD) multiplied 4 bags per day multipliednumber of CAPD patients	18,695,410 (578,619)
	Total direct medical cost	24,961,753 (772,561)
	CAPD service center	Direct medical cost (budget allocate from NHSO)		- Tenckhoff’s insertion - Self-care CAPD training - Lab. test - Drugs - Follow up - giving consultant via social application or telephone	-Patients and/or caregivers manage home CAPD correctly - Decrease complication of CAPD - Decrease travel expenses of patients and caregivers
				for unnecessary treatment at CAPD service center
CAPD patients and Caregivers	Direct non-medical cost - transportation and food expenses for appointments (transportation cost + food expenses) multiplied number of appointments in one year multiplied number of CAPD patients	558,384 (17,282)	- House renovation - Home CAPD - Follow up - Plastic waste recycling	- Decrease complication of CAPD treatment - Slow progression of ESRD - a reduction in isolation and loneliness - an increase in wellbeing from having a sense of purpose of survival - feeling part of community - a reduction in stress and burden of care for both CAPD patients and caregivers
	House renovation and medical equipment cost for CAPD room 1 room multiplied number of CAPD patients	3,805,900 (117,792)
	- material cost for CAPD 4 times/day multipliednumber of CAPD patients	722,640 (22,366)		- correct waste disposal
	- opportunity cost average daily wage multipliednumber of CAPD patients and caregivers multiplied number of appointments	654,620 (20,260)
	Total direct non-medical cost	5,741,544 (177,700)
	Indirect cost - opportunity cost opportunity cost multiplied 54 CAPD patients who admitted due to CAPD complications	68,483 (2,120)	Admitted due to CAPD complication	- continue CAPD treatment or change to hemodialysis
	Total investment of CAPD project (after adjusting the currency in the year 2016 to 2018)	30,771,780 (952,380)

Notes: *Adjust the currency in the year 2016 to 2018. The reference in the year 2018 was 32.3104 THB: 1 USD.

Abbreviations: NHSO, The National Health Security Office; CAPD service center, Continuous Ambulatory Peritoneal Dialysis Center service; CAPD patient, End-stage Renal Disease’s patient treated with Continuous Ambulatory Peritoneal Dialysis modality under Universal coverage scheme; THB, Thai Baht; USD, United States Dollar.

Table 3 Outcome, Outcome Indicator Financial Proxies And Social Value

Stakeholders	Outcomes (What Changes)	Outcome Indicator	Sources	Duration (Year)	Financial Proxy And Value THB (USD)
NHSO	The good quality of life of CAPD patients, not being the burden of society and ready for KT in the future	Saving health expenditure in the public sector	Teerawattananon et al, 2007^Citation7	1	Number of patient does not treat by palliative care (N=191)multiplied Palliative care cost 33,544,843 (1,038,206)
		1	Number of patient does not admit due to CAPD complications (N=137) multiplied complications cost 4,842,458 (149,873)
		Total			38,387,301 (1,188,079)
CAPD patients and Caregivers		Increase household income	Patients and/or caregivers interview	1	Number of patients (N=141) and caregivers (N=50) going back to work multiplied Average daily wage multiplied365 days 12,956,400 (400,998)
					Number of patients or caregivers consulted with PD nurses via social application or telephone (N=191) muliplied opportunity costs, food and transportation costs multiplied average number of consultation in 1 year (N = 4 times) 127,392 (3,943)
					Number of patients (N=179) multipliedWaste recycling price multipliedkilogram multiplied365 days 457,345 (14,155)
		Total			13,541,137 (419,095)
Discount 19% for attribution to CAPD patients and caregivers					10,968,321 (339,467)
Total social value of the CAPD project invested by NHSO					49,355,622 (1,527,546)

Abbreviations: NHSO, The National Health Security Office; CAPD service center, Continuous Ambulatory Peritoneal Dialysis Center service; CAPD patient, End-stage Renal Disease’s patient treated with Continuous Ambulatory Peritoneal Dialysis modality under Universal coverage scheme; THB, Thai Baht; USD, United States Dollar.

Tantivess S, Werayingyong P, Chuengsaman P, Teerawattananon Y. Universal coverage of renal dialysis in Thailand: promise, progress, and prospects. BMJ. 2013;346:f462. doi:10.1136/bmj.f46223369775

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