Lesson learnt from implementing a CRRT reimbursement program in a resource-limited setting

Abstract

Acute kidney injury (AKI) poses significant risks, including high mortality and progression to chronic kidney disease. Effective treatment modalities include peritoneal dialysis (PD), intermittent hemodialysis (IHD), sustained low-efficiency dialysis (SLED), and continuous renal replacement therapy (CRRT). While each modality has specific advantages, CRRT is particularly vital for critically ill patients with severe AKI and contraindications for IHD. Despite its clinical benefits, the high cost of CRRT presents challenges, especially in resource-limited settings like Thailand.

This manuscript reviews the process of integrating CRRT into Thailand's Universal Coverage Scheme (UCS). Initial proposals in 2017 highlighted CRRT's importance, yet its high costs posed barriers to inclusion. A rigorous policy development process, emphasizing evidence-based and participatory decision-making, led to the proposal's acceptance in 2018. Key recommendations included optimizing reimbursement rates and increasing budget allocations.

By 2022, CRRT reimbursement was incorporated into the UCS, significantly improving access to treatment for patients with AKI. Specific outcomes from our 2-year policy implementation, including patient outcomes such as mortality, renal recovery, length of hospital stay, and complications, as well as cost-saving outcomes reflecting the need for intensive care resources, are ongoing. These cost-benefit analyses, along with policy adjustments, are necessary to ensure continued equitable and effective treatment. This case underscores the importance of aligning reimbursement strategies with clinical needs and financial realities to enhance both healthcare outcomes and system sustainability.