Abstract

JULIAN-MAURO, Juan C.; CUERVO, Jesús; REBOLLO, Pablo  and  CALLEJO, Daniel. Employment status and indirect costs in patients with renal failure: differences between different modalities of renal replacement therapy. Nefrología (Madr.) [online]. 2013, vol.33, n.3, pp.333-341. ISSN 1989-2284.  https://dx.doi.org/10.3265/Nefrologia.pre2012.Dec.11767.

Background: There is evidence of a different employment status between patients undergoing different modalities of renal replacement therapy (RRT). Objectives: The present study aims to compare the indirect costs associated with morbidity in the following RRT alternatives: haemodialysis in a specialised center (HD), automated peritoneal dialysis (APD), continuous ambulatory peritoneal dialysis (CAPD), and kidney transplant (TX). Method: We analysed indirect costs following the Human Capital Theory. In total, 243 patients of working age were included (32 CAPD, 46 APD, 83 HD, and 82 TX) from 8 hospitals. The potentially productive years of life lost (PPYL), the costs of lost labor productivity (LLPc) for the year 2009, and the total cost of PPYL (PPYLtc) until age of retirement were estimated. All estimations were adjusted by age and sex. Non-parametric analysis (bootstrap confidence intervals of differences in costs calculated following the simple bias-corrected percentile method -1,000 estimates-) was computed to highlight differences in costs. Results: No significant differences were found in age or sex between groups. In 2009, LLPc for HD (6547€; 95% CI: 5727€-7366€) was significantly higher (P<.001) than for TX (5079€; 95% CI: 4127€-6030€) or APD (4359€; 95% CI: 3064€-5655€), but not CAPD (5785€; 95% CI: 4302€-7269€). PPYL values were: HD: 12.58 years, 95% CI: 10.42-14.73; TX: 10.05, 95% CI: 7.45-12.65; APD: 6.09, 95% CI: 3.43-8.74; CAPD: 10.69, 95% CI: 6.14-15.23. PPYLtc was higher in HD than in TX, APD or CAPD in all scenarios tested. Conclusions: TX are the modalities of RRT with the lowest impact on indirect costs due to morbidity, resulting in higher rates of employment than HD and requiring less disability benefits.

Keywords : Renal replacement therapy; Dialysis; Indirect costs; Employment status.

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