Prospective analysis of global costs for maintenance of patients with ESRD

The prevalence of end-stage renal disease (ESRD) has doubled in the past decade, with total costs projected to exceed 16.5 billion dollars by the end of 2002.

The purpose of this prospective study is to determine all costs related to inpatient and outpatient health care utilization incurred by 76 patients with ESRD in an outpatient hemodialysis setting for 1 year. Costs were derived from a computer-based cost-allocation process that distributed cost components and overhead to designated revenue-producing departments.

During the 1-year study period, these patients had 1,459 total inpatient and outpatient hospital visits (mean, 19.2 visits/patient; range, 0 to 84 visits/patient). There were 149 general inpatient hospital admissions. Of 238 total emergency room visits, 89 visits resulted in admission to the hospital (37%).

Total hospital costs for all patients for the year were 1,831,880 dollars (actual charges, 2,929,147 dollars). As expected, the greatest hospital cost expenditures were attributed to inpatient hospital admissions (1,419,022 dollars; 77.5% of total). Of total hospital costs, inpatient bed costs were the single highest expenditure. The cost for outpatient hemodialysis therapy was 33,784 dollars/patient-year, consisting of facility costs of 17,200 dollars, outpatient pharmacy costs of 14,100 dollars, and outpatient professional costs of 2,500 dollars/patient-year. Average costs for hospital facility and/or professional fees were 42,730 dollars/patient-year, whereas average costs for outpatient dialysis facility and/or professional fees were 33,784 dollars, for an estimated global cost of 76,515 dollars/patient-year. Our cost estimate for care of this unique inner-city population substantially exceeds those reported earlier by others.