2020, Number 1
Burden of disease: end stage renal disease, dialysis-hemodialysis and kidney transplantation in Mexico
Sánchez-Cedillo A, Cruz-Santiago J, Mariño-Rojas FB, Hernández-Estrada S, García-Ramírez C
Full text
10.35366/94025
Language: Spanish
References: 20
Page: 15-25
PDF size: 305.60 Kb.
ABSTRACT
Introduction: Chronic Kidney Disease (CKD) is a multifactorial disease of a progressive and irreversible nature, in which renal function is impaired that in end stages requires renal replacement therapies (RRT). The high cost of CKD replacement therapy will represent a major challenge for health systems. Mexico is a country in which the use of peritoneal dialysis has historically predominated, although hemodialysis has recently been encouraged. On the other hand, in Mexico, hemodialysis remains poorly accessible for most patients. Kidney transplantation (KT) is the only modality of RRT that really prevents the development of uremia, but, unfortunately, not all patients with CKD are candidates for KT. For this reason, a thorough evaluation of the candidates for KT is necessary in order to maximize economic and human resources. Objective: To determine the alternative of lower cost of care in patients with Dialysis-Hemodialysis compared to patients in KT from the perspective of two public institutions such as the Mexican Social Security Institute (IMSS) and the Institute of Social Security and Services of State Workers (ISSSTE). Material and methods: Retrospective study, to estimate the average costs of Dialysis-Hemodialysis and KT care. The estimated average costs in health were evaluated from the point of view of public health service providers, in this case the IMSS and ISSSTE. The frequency of use of resources of patients with dialysis-hemodialysis and KT was estimated through the information of the care experience of the treating physicians of each Institution during 2017. Only the direct medical costs of the patients were considered (inputs and/or resources used in one year), with a follow-up after year three and six of follow-up. Results: The average annual cost of care per capita for the first year of dialysis-hemodialysis was $ 465,485.96 and $ 783,780.44 respectively, the cost for complications in the case of Dialysis being the heaviest representing 54.6% of the total cost of care while in patients with hemodialysis, treatment sessions accounted for 50.8% of the total cost. The average annual cost of care for patients with KT per capita for year 1 was $ 862,490.51, where the cost for complications was the one that generated the greatest care expense, representing 52.6% of the total cost of care. When monitoring (year three and six), there is a decrease in the costs of patients with KT, with a decrease in the cost against Dialysis of 44 and 43%, as well as 36 and 39% compared to patients in hemodialysis respectively. Conclusions: KT proved to be the lowest cost alternative for the management of these patients, being hemodialysis the most expensive therapy. From an economic perspective, the KR should be the intervention with the greatest promotion and application regarding the three RRT.REFERENCES
Franco-Marina F, Tirado-Gómez L, Venado-Estrada A, Moreno-López J, Pacheco-Domínguez R, Durán-Arenas L, López-Cervantes M. Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México. Salud Pública Mex. 2011; 53 Supl 4: S506-S515.