[Reduced costs of hospitalization at the start of hemodialysis by previous creation of an AV-fistula. Investigation of the Austrian system of financing data of incident patients from 1999 to October 2000 at the Landeskrankenhaus Innsbruck University clinic].

Abstract

Costs of renal replacement therapy are enormous, of which hospitalisation is a major factor. International and national guidelines recommend early creation of fistulas before the start of the haemodialysis. The aim of this study is to calculate the costs of the initial hospitalisation of all incident patients (n = 79) based on the data of the "leistungsorientierte Krankenhaus-finanzierung", which means the Austrian system of financing hospital care according to interventions and diagnosis-groups in the years 1999 and 2000 at the Landeskrankenhaus Innsbruck. The average costs of the hospitalisation at the start of haemodialysis treatment are not significantly different when comparing haemodialysis patients (n = 69) to peritoneal dialysis patients (n = 10). Patients on haemodialysis were divided into two groups, depending on the presence of a usable AV-fistula at the start of the haemodialysis treatment. Costs for both groups differ significantly; for patients of the shunt-group (n = 28) at 4.437 +/- 567 [symbol: see text] they are less than half as high as costs for unprepared patients (no-shunt-group, n = 41) at 9.704 +/- 783 [symbol: see text]. Diagnosis dependent costs (Tageskostenanteile) are 75% higher for patients without shunt compared to patients of the shunt group (4040 vs. 2300 [symbol: see text]). Patients without shunt are hospitalised significantly longer than patients with shunt (18.85 vs. 12.03 days) and qualify less often for kidney transplantation than patients with shunt (28.9% vs. 61.3%). In summary, the data of the "leistungsorientierte Krankenhausfinanzierung" in combination with clinical data (availability of a useable dialysis access, enrolment in kidney transplantation) gives us reliable information on days of hospitalisation, number of dialysis treatments and costs of hospitalisation upon initiation of renal replacement therapy. Based on these data, the rigorous creation of sufficient AV-fistula prior to the start of haemodialysis in all incident patients can save up to 66.400 [symbol: see text]/year of inpatient costs at the Landeskrankenhaus Innsbruck.