Medical experts have stressed the need for developing cost-effective and equitable access to dialysis in various countries including India where 2 lakh patients are in need of the therapy every year.
Experts in the new research paper titled 'Ethical issues in dialysis therapy' published in the Lancet today said that a mere 30 per cent of patients manage to receive this life-saving therapy in India.
"Efforts to providing affordable dialysis to those with end-stage kidney disease should be done in conjunction with more cost-effective efforts to prevent its development and reducing its progression using proven methodologies," the paper argued.
This comes after the Indian government has initiated a National Dialysis Services Programme to provide dialysis services in all district hospitals.
Health Ministry officials had recently said that the programme is already running in 294 district hospitals, and approval has been given to 516 such hospitals.
The paper said the global market for dialysis was valued at more than USD 75 billion in 2011 and the costs of providing dialysis and the costs incurred by patients needing dialysis, vary between and within countries.
"In the USA, 4,68,000 people received dialysis in 2013, with a total medicare spend of USD 30.9 billion, representing 7.1 per cent of total health-care expenditure. In Thailand in 2008, an estimated 12,000 people received dialysis at a cost of USD 76 million, or 2 per cent of national health-care expenditure.
"The average annual cost of providing dialysis to a patient under bundling was USD 31,000 in the USA in 2011, compared with approximately USD 3,200 in India in 2014," the paper said.
According to a systematic review of worldwide access to treatment for end-stage kidney disease published in the Lancet in 2015, an estimated 2.28 million patients died in 2010 because of non-availability or unaffordability of dialysis, almost all in low-income and lower-middle income countries like India.
In India, almost 2,00,000 new patients need dialysis every year, and it is estimated that less than 30 per cent of patients manage to receive this life-saving therapy.
"As we in India embark on an ambitious national dialysis control program, we must ensure that minimum standards of quality and safety are established for dialysis units and regulations introduced where necessary to ensure standards are maintained," said Vivekanand Jha, the lead author of the paper.
Jha, who is also the executive director of the George
Institute for Global Health India, said that audit systems should be designed to facilitate and encourage documentation of patient care and transparent reporting of costs to provide an evidence base for decision making and objective evaluation of performance.
The paper said these costs of dialysis in various countries usually cover only the dialysis treatment itself, and not ancillary expenses such as medications or transportation.
"Factors that affect the absolute costs include the local economy for health-care products and services, the funding model for dialysis, and the healthcare system.
"These factors determine if, and how much, patients are required to pay upfront for dialysis. For example, the cost of a haemodialysis session to patients in different facilities in India can vary from USD 10 to USD 50.10," the paper said.
The paper argued that health systems should establish programs of kidney disease prevention and health promotion in conjunction with dialysis and transplantation programs.
It also argues that health professionals and policy makers should strive to reduce the costs of dialysis, using simple, safe and affordable modalities without compromising the quality of therapy provided to the patients.
"The aim of equitable access to renal replacement therapy and best practice care for all patients with end-stage kidney disease presents major ethical, practical and economic challenges for health-care systems.
"These challenges include increasing access to dialysis, helping patients and families to make the best decisions about management of advanced kidney failure and ensure that patients receive affordable high quality chronic dialysis that is based on standards accepted worldwide," Jha said.
Dominique Martin of Deakin University at Melbourne, one of the co-authors of the paper said physicians have an obligation to provide information about risk and benefits of dialysis and to support patients or their surrogate decision makers in qualitative evaluation of treatment options.
"People must be given enough information about the risk and consequences of dialysis so that they can start making decisions about initiation and withdrawal," he said.
