G GORHAM1, K HOWARD2, Y ZHAO3, A AHMED1, P LAWTON1, C SAJIV3, S MAJONI3, P WOOD3, S SIGNAL3, T CONLON3, S ROBINSON3, S BROWN4, A CASS1
1Menzies School Of Health Research, Casuarina, Australia, 2Sydney School of Public Health, University of Sydney, Sydney, Australia, 3NT Department of Health, Darwin, Australia, 4Western Desert Nganampa Walytja Palyantjaku Tjutaku , Alice Springs, Australia
Background: Maintenance dialysis is costly and resource intense. Inadequate health infrastructure and access to technically skilled staff can limit service provision in remote areas. Most dialysis cost studies are based on urban satellite dialysis service provision and few studies include broader costs often borne by patients. In the NT these costs are carried by the government.
1. To identify the challenges in providing reliable costs estimates of different dialysis models of care (DxMoC) and
2. To calculate the service costs for DxMoC in regional and remote Australia for comparative analysis with the National Efficient Price (NEP) and previous cost studies.
Methods: Financial data for all renal services in the NT was sourced from funders for the period 2008-2014. Data was analysed by cost category and miscoded data was reallocated to appropriate cost centres. Missing and centralised costs were standardised using $2017 actual unit costs. For comparison across models of care and with the NEP, all costs were inflated to 2016-7 dollars using the AIHW Total Health Price Index (HPI). Adjustments, in accordance with NEP methodology, were made for remoteness and Indigenous status.
Results: DxMoC1 ($457-$529) and 2 ($437-$516), (urban and regional) were less than the NEP cost per treatment ($586-$638) while DxMoC3 and 4 ($710-$718) (remote and very remote nurse-supported) were higher than the NEP ($664). Self-care therapies were more costly than in other jurisdictions due to training length (differing language, culture and reduced health literacy) and costs not traditionally borne by governments (electricity, leasing and travel).
Conclusion: Remote dialysis services incur higher salary and fixed costs and NEP adjustments are insufficient to meet the actual costs of delivering services to remote-living Indigenous Australians.
Gillian has 20 years experience as a senior renal manager in the Northern Territory and was involved in the design and establishment of many of the dialysis service models. She has worked with local, state and national bodies in the development of renal strategic documents. Gillian is currently the Renal Research Program Manager at Menzies School of Health Research and oversees a number of projects evaluating models of service delivery. She is currently a PhD candidate.