The marginal cost of satellite versus in-center hemodialysis

Background: Despite increasing numbers of patients receiving hemodialysis in satellite units (SHD), the economic aspects have not been widely explored. A cost analysis of SHD and in-center hemodialysis (ICHD) from a societal perspective was performed to establish the efficiencies associated with shifting resources and patients from ICHD to SHD. Methods: Costs were classified as fixed or variable and placed into categories. The resources for operating a SHD unit are the sum of two components: total fixed costs (TFC) and average variable cost (AVC) times SHD patient volume (Q). Using the TFC of a specific-sized SHD unit and the difference in AVC between ICHD and SHD the number of patients needed (Q) in the SHD unit for financial viability was determined. The formula TFC=(AVC_ICHD-AVC_SHD)X Q was used to determine the number of patients (Q) needed in a specific-sized SHD unit such that the yearly cost of SHD treatment would be the same as ICHD treatment. Results: Our results show that SHD fixed costs can be fully offset if the volume of SHD patients is seven per year in a six-station unit. SHD costs were lower for nursing and physician fees. Therefore, ICHD care variable costs were $11,374 more per patient year. SHD patients would also have lower travel costs, a mean cost saving of $12,364 per year. Conclusion: SHD can result in significant savings both to the health-care system and to patients. Using the cost categories and formula presented, the number of patients needed in a specific-sized satellite unit to realize cost savings was determined for our program. We found that these savings can offset the fixed investment needed to operate a SHD unit at modest patient volumes.