The marginal cost of satellite versus in-center hemodialysis

Despite increasing numbers of patients receiving hemodialysis in satellite units (SHD), the economic aspects have not been widely explored. A cost analysis of SHD and in-center hemodialysis (ICHD) from a societal perspective was performed to establish the efficiencies associated with shifting resources and patients from ICHD to SHD.

Costs were classified as fixed or variable and placed into categories. The resources for operating a SHD unit are the sum of two components: total fixed costs (TFC) and average variable cost (AVC) times SHD patient volume (Q). Using the TFC of a specific-sized SHD unit and the difference in AVC between ICHD and SHD the number of patients needed (Q) in the SHD unit for financial viability was determined. The formula TFC = (AVC(ICHD) - AVC(SHD)) X Q was used to determine the number of patients (Q) needed in a specific-sized SHD unit such that the yearly cost of SHD treatment would be the same as ICHD treatment.

Our results show that SHD fixed costs can be fully offset if the volume of SHD patients is seven per year in a six-station unit. SHD costs were lower for nursing and physician fees. Therefore, ICHD care variable costs were $11,374 more per patient year. SHD patients would also have lower travel costs, a mean cost saving of $12,364 per year.

SHD can result in significant savings both to the health-care system and to patients. Using the cost categories and formula presented, the number of patients needed in a specific-sized satellite unit to realize cost savings was determined for our program. We found that these savings can offset the fixed investment needed to operate a SHD unit at modest patient volumes.