Comparative Costs of Different Renal Replacement Therapies in Lower Middle Income Countries on the Example of Georgia

Abstract

INTRODUCTION & OBJECTIVES: End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care that majority of the patients cannot afford. Therefore, in many countries expenses associated with the ESRD treatment is covered by state government. These treatment options include: hemodialysis, peritoneal dialysis and kidney transplantation. Multiple studies have been conducted throughout the world to assess cost-effectiveness of these treatment modalities. The studies suggest that kidney transplantation not only reduces mortality and morbidity but improves a quality of life of ESRD patients. Furthermore, it is the most cost-effective treatment for the ESRD at least in high-income countries. The goal of our study was to determine, whether above-mentioned is true for low- and middleincome countries, where the costs of the ESRD treatment is substantially lower. MATERIAL & METHODS: The costs of dialysis treatment (hemo and peritoneal) were analyzed based on the data from the last three years and compared to the total cost of kidney transplant operation and post-transplant immunosuppression. RESULTS: The cost for one hemodialysis session paid by the Georgian state government is 40 GEL (USD 16) and the cost of disposables is 48 GEL, which makes up total sum of 88 GEL (approx. USD 37). Obviously, this is an inexpensive treatment as compared to high-income and even majority of low- and middle-income countries throughout the world. Our analysis has shown that the total cost of the transplant operation and immunosuppression is much higher than the dialysis treatment in the first post-transplant year. However, the costs equalize in less than 2.5 years, after which the annual cost of the transplant is 2.5 times less than the dialysis treatment. In a long run, peritoneal dialysis is the most expensive form of renal replacement therapy (RRT) followed-up by hemodialysis and renal transplantation (figure). CONCLUSIONS: Despite the low dialysis costs, transplantation remains the cheapest form of RRT in low income countries like Georgia. This could be a good financial argument for state government to try to maximize the number of kidney transplantations and reduce the number of patients on maintenance dialysis, mainly by introducing the deceased-donor transplantation system which isn't still active in the country.