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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1072 — Cost of End-Stage Renal Disease Care for Veterans Receiving Dialysis in VA vs. Non-VA Facilities

Author List:
Stroupe KT (Edward Hines, Jr. VA Hospital)
Hynes DM (Edward Hines, Jr. VA Hospital)
Kaufman JS (Boston VAMC)
Reda DJ (Edward Hines, Jr. VA Hospital)
Browning MM (Edward Hines, Jr. VA Hospital)
Huo Z (Northwestern University School of Medicine)
Arnold N (Edward Hines, Jr. VA Hospital)

Objectives:
Veterans with end-stage renal disease (ESRD) require chronic dialysis to replace lost kidney function. Dialysis costs have been estimated to be over $50,000/year. Since most veterans become eligible for Medicare three months after initiating dialysis, they may receive dialysis care in either VA or non-VA facilities. We compared costs for veterans who received dialysis at a VA facility to costs for veterans who received dialysis at a non-VA facility.

Methods:
Data were from a VA HSR&D-funded multi-site prospective observational study of hemodialysis patients at 8 VA facilities in 2001-2003. We enrolled 341 patients; 183 were dialyzing at VA and 153 at non-VA facilities. We examined the association of health insurance, demographics, and clinical factors with dialysis venue (VA vs. non-VA), using multivariable logistic regression analysis. We estimated total direct and indirect (time, travel, and caregiver) healthcare costs and examined differences in patients’ average monthly costs by dialysis venue (VA vs. non-VA facility).

Results:
Patients dialyzing at VA had lower health status (e.g., lower hemoglobin, lower albumin), lived closer to a VA, and had less non-VA insurance. Average monthly direct costs for all healthcare were $1,593 (95% CI: $639 to $2,673) higher for patients using VA dialysis ($6,668 vs. $5,075). Average monthly inpatient costs were $1,491 (95% CI, $579 to $2,676) higher for patients using VA dialysis ($2,830 vs. $1,339); however, monthly dialysis costs ($2,850 VA vs. $2,797 non-VA) and non-dialysis outpatient costs ($853 VA vs. $810 non-VA) were similar (p > 0.6). Average monthly indirect costs for healthcare were $486 (95% CI, $226 to $749) higher for patients using VA dialysis ($2,035 VA vs. $1,549 non-VA).

Implications:
Both direct and indirect costs were higher for patients using VA dialysis. Veterans using VA dialysis had lower health status and significantly higher inpatient costs than veterans receiving non-VA dialysis, indicating that VA is treating more severely ill patients.

Impacts:
Because veterans with ESRD are eligible for Medicare, VA policymakers may consider transferring expensive dialysis care from VA to Medicare-covered facilities. However, the VA may be particularly important for providing comprehensive care to those veterans who are most ill and most in need of intensive care.


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