Evidence on outsourcing dialysis services: a scoping review

Area of Science:

• Nephrology
• Health Economics
• Public Health Policy

Background:

• Chronic kidney disease (CKD) is a significant global health issue with high incidence, prevalence, morbidity, mortality, and socioeconomic burden.
• Dialysis is a critical treatment for end-stage renal disease, with various service delivery models.
• Understanding the comparative effectiveness and economic implications of different dialysis provision models is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To compare the effectiveness and economic consequences of outsourced (subsidized) versus hospital-based dialysis services.
• To analyze cost-effectiveness and identify factors influencing hospitalization and mortality rates in different dialysis settings.

Main Methods:

• A scoping review of relevant literature was conducted using multiple databases.
• Included studies compared the effectiveness of contracted versus in-hospital dialysis.
• Cost analyses focused on the Spanish context, including public pricing across Autonomous Communities.

Main Results:

• Eight effectiveness studies (all US-based) and three cost studies were reviewed.
• Subsidized centers showed higher hospitalization rates, but no significant differences in mortality were observed.
• Hospital hemodialysis is more expensive than outsourced dialysis due to structural costs; significant variability in public pricing for dialysis services exists across Spanish regions.

Conclusions:

• The study highlights the coexistence of public and outsourced dialysis centers in Spain, with considerable variability in service provision and costs.
• Limited evidence exists on the effectiveness of outsourced dialysis treatments.
• There is a need to promote strategies for improving chronic kidney disease care, considering both effectiveness and economic factors.