Ms Stephanie Notaras1,2, Dr Martin Howell3, Professor Kirsten Howard3, Professor Angela Makris1,2
1Liverpool Hospital, Liverpool, Australia, 2Western Sydney University, Campbelltown, Australia, 3Sydney University School of Public Health, 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 undertaking a PhD in renal nutrition with a special interest in pre-dialysis dietetic interventions and reducing the progression of kidney disease. Stephanie has a Master in Social Health and Counselling and is a guest lecturer for the Nutrition and Dietetics degree at the University of Wollongong.