Gorham, Gillian

Howard K

Zhao, Yuejen

Ahmed AMS

Lawton, Paul

Sajiv, Cherian

Majoni, Sandawana William

Wood, Pamela

Conlon T

Signal, Selina

Robinson SL

Brown S

Cass A

2019-06-25

Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia's Northern Territory (NT). We undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars. There was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies. The cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location.

Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia. Gillian.Gorham@menzies.edu.au..

Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia..

Primary Health, Hobart, Tasmania, Australia..

Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia.. Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia..

Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.. Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia.. Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia..

Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia..

Western Desert Nganampa Walytja Palyantjaku Tjutaku Northern Territory, Alice Springs, Australia..

Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia..

BMC Nephrol . 2019 Jun 25;20(1):231. doi: 10.1186/s12882-019-1421-z.

0000-0002-9814-2204

https://pubmed.ncbi.nlm.nih.gov/31238898/?otool=iaurydwlib

https://hdl.handle.net/10137/7666

Aboriginal

Costs

Dialysis

Expenditure

Remote

Rural

Cost of dialysis therapies in rural and remote Australia - a micro-costing analysis.

Journal Article

Publication