Appendix A. Supplementary information for Table 1, including the cost calculation for
hospitalization and dialysis access.
Appendix Table A1 Hospital costs per day for manuscript table 1
Type
State/Local Non-Profit For-Profit
Government Hospitals
Hospitals
Hospitals
Cost1
$1,667
$2,088
$1,628
2
Percentage
21%
58%
21%
Weighted Average Single Day
$1,902
Cost (2009 $)
Cost Per Day in 2013 $ for the
$2,024
Model3
1. From Kaiser foundation web page on adjusted expenses per inpatient day.(20)
2. From the American Hospital Association, Fast Facts on US Hospitals.(19)
3. Inflation from the medical consumer price index information for Urban locations from the
Bureau of Labor Statistics.(18)
Appendix Table A2 Access costs in detail for manuscript table 1
Subtype
Distribution
Costs
Weighted
(%)
costs
PD access
Laproscopy
50%
$2,716
$2,492.30
Percutaneous1
50%
$2,268
Temporary Femoral +
34%
$2,784.62
HD access Cuffed
catheter2
Uncuffed +
22%
$2,784.62
$2,437.09
Cuffed
catheter2
Cuffed
44%
$1,994.68
catheter2
HD
AVF
61%
$3,099.95
permanent AVG
$2,789.96
39%
$3,099.95
3
access
Dual4
Initial Femoral 61%
$789.84
$789.84+
Initial Uncuffed 39%
$789.84
$2,492.30
PD
100%
$2,492.30
1. CMS costs by CPT codes as follows for Laproscopy, Percutaneous: 49421, 49324.(21)
2. CMS costs by CPT codes as follows for femoral, uncuffed, cuffed: 36556 36558, 36563.(21)
3. Assumes 90% of HD patients receive the permanent access surgery within 90 days based on
Gomes.(22)
4. CMS costs by CPT code 36556.(21)
Appendix B. Supplementary information for Table 2, including detailed information for facility
costs, personnel, supplies, lab, and medications.
Appendix Table B1 Facility costs for manuscript table 2
subtype
Months1
PD
Costs per patient
month2
$445
$123
$445
$445
$445
$123
In-clinic PD
0.5
Home PD
2.5
HD
HD
3
Dual
ICHD Days 0-2
0.067
ICPD Days 3-16 0.5
Home PD Days
2.5
17-90
1. Number of month estimates from the survey.
2. Costs per patient month from Hornberger 2012 Table 1.(4)
Total costs
$530.00
$1,335.00
$559.67
Appendix Table B2a Personnel costs (salary) for PD for manuscript table 2
Total PD personnel cost
$2,210.25
$3,157.50
Days 0-90
minutes
Cost per
Total Salary Total
minute
Costs1
Medical Director fee2
$90
$128.57
Nurse
3660
$0.54
$1,992.26
$2,846.09
Dietician
50
$0.45
$22.50
$32.14
Social worker
180
$0.41
$74.22
$106.03
Financial coordinator
45
$0.54
$24.17
$34.53
Clinic manager
10
$0.71
$7.11
$10.16
1. Based on mean hourly wages, adjusted to reflect costs of benefits (30%), from the US Bureau
of Labor Statistics and survey responses for time all converted to minutes.(23,24)
2. Medical Director Fee from expert opinion.
3. For dual patients, the personnel costs include all the costs for urgent-start PD plus 2 hours
technician time and 40 minutes nurse time. As a result, the total estimated salary cost is
$2,568.99.
Appendix Table B2b Personnel costs for HD for manuscript table 2
Total HD Personnel Days
$1,541.11
$2201.58
Cost1
minutes
Cost per Total Salary
Total Cost
minute
Medical Director fee2
$90
$128.57
Technician
2340
$0.36
$832.65
$1,189.50
Nurse
780
$0.54
$424.58
$606.54
Dietician
50
$0.45
$22.50
$32.14
Social worker
195
$0.41
$80.41
$114.87
Machine Tech
195
$0.31
$59.70
$85.29
Financial coordinator
45
$0.54
$24.17
$34.53
Clinic manager
10
$0.71
$7.11
$10.16
1. Based on mean hourly wages, adjusted to reflect costs of benefits (30%), from the US Bureau
of Labor Statistics and survey responses for time all converted to minutes.(23,24)
2. Medical Director Fee from expert opinion
Appendix Table B3a PD Supply costs for days 0-14 for manuscript table 2
Total PD supplies cost days 0-14
$270.40
1
Units
Unit cost
Total cost
2
Machine
0.5 months
$250.00
$1252
3
Reclining chair
0.5 months
$1,121.43
$4.303
PD solution 1.5% 6L
6
$10.004
$60.00
4
Integrated APD set (including
6
$12.00
$72.00
cassette, tubing, and drain bag)
Minicap
6
$0.354
$2.10
4
Other (including dressings and
14
$0.50
$7.00
gloves)
1. Estimates from the survey.
2. Based on monthly rent over 2 weeks, the rent itself was based on internal estimates from
Baxter.
3. Based on 5 year life of chair, $1,121.43 cost from the FMC catalog, and zero resale value
using discounted annuitization with a 3% annual rate then converted to weekly costs (FMC
Catalog for prices, Hornberger for time horizon).(4, 25)
4. Supply costs based on internal Baxter estimates of average sales prices to dialysis clinics.
Appendix Table B3b PD Supply costs for days 15-90 for manuscript table 2
Total home services and supplies cost
$2,706.10
Units
Unit cost
Total cost
1
Home Cycler rent for 2.5 months
2.5 months
$99.00
$ 247.50
1
PD solutions (2 bags/day)
152
$10.00
$1520.00
Integrated APD set (including cassette,
76
$12.001
$912
tubing, and drain bag)
Minicap
76
$0.351
$26.60
1. Supply costs based on internal Baxter estimates of average sales prices to dialysis clinics.
Appendix Table B3c HD Supply costs for 90 days for manuscript table 2
Total HD supplies cost
$1399.86
Units unit cost
total cost
Machine & maintenance
39
$11,5001
$164.121
Dialysis chair
39
$1121.432
$15.302
1
Water treatment system &
39
$110,000
$85.541
maintenance (24 stations)
Dialyzer
39
$11.003
$4293
Dialysis needles (0.40)*2
78
$0.403
$31.23
Dialysis blood set
39
$3.003
$337.633
3
Saline
78
$1.25
$39.043
Heparin (5000 units/session)
39
$6.303
$245.703
Dialysate (Bicarbonate + Acid)
39
$4.003
$156.003
(central supply)
Other, including dialysis
39
$1.003
$39.003
syringes, gloves, and dressings
1. Supply costs based on internal Baxter estimates of average sales prices to dialysis clinics, time
horizons from Hornberger and using a 3% rate to annuitize the costs. Further, maintenance costs
of $1.25 per patient per session costs were included for both the dialysis machine and and the
water treatment system. Annuitized costs used 7 years for the dialysis machine and 9 years for
the water treatment system from Hornberger.(4) Also assumed that the water treatment system
could treat 80 patients based on Hornberger and that the machine could treat 6 patients per
week.(4)
2. Based on 5 year life of chair, $1,121.43 cost from the FMC catalog, and zero resale value
using undiscounted annuitization with a 3% annual rate then converted to weekly costs (FMC
Catalog for prices, Hornberger for time horizon).(4, 25) 3. Supply costs based on internal Baxter
estimates of average sales prices to dialysis clinics.
Appendix Table B3d Dual patient supply costs for manuscript table 2
Total dual patients cost per patient
$2,977.08
Total cost per session
type
HD Supply Costs Days 0-2
$71.791
In Center PD supply costs days 3-16
$270.402
Home PD Cost days 17-90
$2,634.893
1. Dual patient costs are HD costs for 2 sessions followed by PD costs. These costs are the
same as those for HD but scaled to 2 sessions.
2. These are the same as for PD in days 0-14 but they reflect days 2-16.
3. These are the same as for PD in days 15-90 except the total is adjusted to reflect 74 days
rather than 76 because HD takes up the first two days of the 90 day period (2,634.89 =
2,706.10*(74/76)).
Appendix Table B4 Lab costs for manuscript table 2
Urgent-start HD
Urgent-start PD
2
Unit
Units Total cost
Units2
Total cost
cost1
CBC
$10.69 3
$32.07
3
$32.07
Hgb
$3.26
6
$19.56
3
$9.78
CHEM 7§
$11.63 3
$34.89
3
$34.89
Albumin
$0.00
3
$0.00
3
$0.00
Calcium
$7.09
3
$21.27
3
$21.27
Phosphorus
$6.52
3
$19.56
3
$19.56
Alkaline
$7.11
3
$21.33
3
$21.33
Phosphatase
Magnesium
$9.21
1
$9.21
1
$9.21
Aluminum
$35.02 1
$35.02
1
$35.02
Iron Profile
$8.90
3
$26.70
3
$26.70
Ferritin
$18.73 1
$18.73
1
$18.73
Lipid Panel
$0.00
1
$0.00
1
$0.00
PTH Intact
$56.74 1
$56.74
1
$56.74
TSH
$23.10 1
$23.10
1
$23.10
25-OH Vit D
$40.70 1
$40.70
1
$40.70
HgbA1C
$13.34 1
$13.34
1
$13.34
HBsAG
$14.20 1
$14.20
1
$14.20
HBsAb
$14.76 1
$14.76
1
$14.76
HBcAb
$16.57 1
$16.57
1
$16.57
Hep C
$19.62 0
$0.00
0
$0.00
TB (2-Stage
$85.20 1
$85.20
1
$85.20
Test)
Total Lab Cost
$502.95
$493.17
1. Costs by CPT code from the National Fee Analyzer.(26)
2. Frequency from the survey.
3. For dual patients, the lab costs include the costs for urgent-start PD plus one additional CBC
test and another CHEM 7§ test. As a result, the total lab test costs equal $515.49.
Appendix Table B5 Medication costs for manuscript table 2
HD (90 days)
%
use
erythropoietin
(EPO)1
Iron Sucrose
(Venofer)
Doxercalcifero
l (Hectorol)
Calcitriol
(Calcijex)
Recombinant
tissue
plasminogen
activator (rTPA)
Total
Medication
Cost
Total
dose1
Unit
cost
PD (90 days)
Total
costs
%
use
Total
dose
Unit
cost
Total
costs
90
220000
$0.01
$2,172.85
50
108000
$0.01
$592.60
80
1200
$0.34
$321.60
67
375
$0.34
$84.17
60
90
$1.85
$99.68
0
1
72
$3.61
$2.60
0
10
2
$84.02
$16.80
0
$2,613.54
$0.00
0
$3.61
$0.00
$84.02
$0.00
$676.76
1.
EPO dose is based on USRDS 2013. For HD 14000/week for Month1, 22000/week for
Month2, 19000/week for Month3; for PD 7500/week for Month1, 10000/week for Month2,
9500/week for Month 3 (USRDS 2013 (Figures 2.5 & 2.11)). (2) The rest of the doses are from
the survey. Costs are from CMS.(27)