An Economic Assessment Model of Rural and Remote Satellite Hemodialysis Units

PLoS One. 2015 Aug 18;10(8):e0135587. doi: 10.1371/journal.pone.0135587. eCollection 2015.


Background: Kidney Failure is epidemic in many remote communities in Canada. In-centre hemodialysis is provided within these settings in satellite hemodialysis units. The key cost drivers of this program have not been fully described. Such information is important in informing the design of programs aimed at optimizing efficiency in providing dialysis and preventative chronic kidney disease care in remote communities.

Design, setting, participants, and measurements: We constructed a cost model based on data derived from 16 of Manitoba, Canada's remote satellite units. We included all costs for operation of the unit, transportation, treatment, and capital costs. All costs were presented in 2013 Canadian dollars.

Results: The annual per-patient cost of providing hemodialysis in the satellite units ranged from $80,372 to $215,918 per patient, per year. The median per patient, per year cost was $99,888 (IQR $89,057-$122,640). Primary cost drivers were capital costs related to construction, human resource expenses, and expenses for return to tertiary care centres for health care. Costs related to transport considerably increased estimates in units that required plane or helicopter transfers.

Conclusions: Satellite hemodialysis units in remote areas are more expensive on a per-patient basis than hospital hemodialysis and satellite hemodialysis available in urban areas. In some rural, remote locations, better value for money may reside in local surveillance and prevention programs in addition support for home dialysis therapies over construction of new satellite hemodialysis units.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Hemodialysis Units, Hospital / economics*
  • Humans
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / therapy
  • Manitoba
  • Models, Economic*
  • Remote Consultation*
  • Renal Dialysis / economics*
  • Resource Allocation / economics*
  • Rural Health Services*

Grant support

TF receives funding from a Graduate Studentship from the University of Manitoba through the Manitoba Health Research Council (now Research Manitoba). (—Research Manitoba, formerly Manitoba Health Research Council. NT is supported by the KRESCENT New Investigator Award and the MHRC Establishment Award. The KRESCENT New investigator award is a joint initiative of the Kidney Foundation of Canada, Canadian Institute of Health Research and the Canadian Society of Nephrology. None of the other authors have any declarations. (—Research Manitoba, formerly Manitoba Health Research Council (—KRESCENT New investigator award. The funders had no role in study design, data collection and analysis, decision to published, or preparation of the manuscript.