Incidence, Cost and Budget Impact of Continuous Renal Replacement Therapy in Thailand

Abstract

Background: Acute kidney injury occurs when the kidneys lose their function over hours or days. If a pharmaceutical intervention is not available, renal replacement therapy can play an essential role in increasing patient’s survival chances. Currently, there are four methods of renal replacement therapy, and the preferred method depends on patient’s clinical indications. The most recent continuous renal replacement therapy (CRRT) already included in the benefit package paid by the National Health Security Office (NHSO), has been commented by providers for low reimbursement hence low access.
Objective: The purpose of the study was to analyze the incidence, cost, and budget implications for acute kidney injury patients requiring CRRT.
Methods: Reviews of literature and the NHSO e-claims during 2016-2019 provided incidence cases needed renal replacement therapy, and the empirical costing approach using standard top-down costing and micro-costing methods for two years from 2 regional hospitals provided framework for a 5-year budget impact analysis at the national scale on provider-insurer perspective.
Results: If there were between 3,540-6,049 acute kidney injury patients requiring CRRT annually in Thailand, the total cost of CRRT would be between 57,502 baht (for 1 CRRT needed) and 116,890 baht (for CRRT needed over the average of 3 days). For a 3,540 acute kidney injury incident cases, the five-year budget impact would be between 1.017 and 2.068 billion baht. For a 6,049 incidence, the budget impact would be between 1.739 and 3.535 billion baht. These findings could assist the NHSO in planning an incentive to support hospitals to provide CRRT and subsequently improving patient access.