S NOTARAS1,2, M HOWELL3, K HOWARD3, A MAKRIS1,2
1Liverpool Hospital, Liverpool , Australia, 2University of Western Sydney , Campbelltown, Australia, 3Sydney University , Camperdown, Australia
Aim: To compare health service costs in a cohort of patients attending a pre-dialysis clinic that did and did not receive dietetic consultation (DC).
Background: DC and its effect on clinical outcomes is an under-researched component of pre-dialysis education. Pre-dialysis DC has been associated with a 7.5-month delay in patients requiring dialysis commencement, having potential cost implications for health services. Limited studies have evaluated the possible impact of pre-dialysis DC on health service costs.
Methods: A cost-analysis comparing health service costs over four years in a cohort of pre-dialysis patients with and without DC. Retrospective study data was used (n=246) along with outpatient renal clinic visits, hospital admissions and Australian Refined Diagnosis Related Groups codes to estimate total health service costs. A generalized linear model was used to compare total costs and marginal effects of DC.
Results: Mean total cost for patients (outpatient visits, admissions and dialysis) was $178,913 (95% CI=$158735-$199090) or $185/day (95% CI=$12-$161). The DC group total costs/day were lower than the no-DC group with a mean difference of $51/day ($155 versus $206;P=0.03). Patients in the DC group had less admissions compared to the no-DC group (6.32 versus 8.06;P=0.02). The highest marginal costs estimated for the entire cohort were lower eGFR at admission $123,511(P=0.001), inpatient admissions $189,333(P<0.001), commencing dialysis $581,812(P<0.001), having diabetes $94,590(P=0.014), and cerebrovascular disease $177,080(P=0.01). DC did not have a marginal influence on total costs.
Conclusion: Patients who received DC had lower total health services costs/day compared to those who did not. Marginal cost analysis indicates the cost difference to be attributed to less time on dialysis and less hospital admissions in this retrospective observational cohort.
Stephanie Notaras is a Senior Renal Dietitian at Liverpool Hospital. She is doing a PhD investigating the effect of dietetic intervention on CKD progression, time to dialysis and health service costs in patients with non-dialysis dependent CKD. Her research has shown an association between pre-dialysis dietetic consultation and a delay in patients requiring dialysis. She has a Masters in Counselling and a special interest in improving clinicians’ communication and counselling skills to help patients achieve better health outcomes.