Healthcare Resource Utilization and Cost of Renal Replacement Therapy in Brazil: A Five-Year Procedure-Level Analysis

OBJECTIVES: To investigate the healthcare resource utilization (HCRU) and associated direct medical costs of renal replacement therapy (RRT) across SUS (Brazilian Unified Health System) and SH (Supplementary Health – health plans and insurances). When a patient with private health insurance uses public health services, the private insurance reimburses SUS for its cost.

METHODS: This retrospective observational analysis was conducted over a 5-year period, from Jan-2015 to Dec-2019, using publicly available administrative claims data from SUS and SH. All inpatient and outpatient RRT procedures authorized by SUS and SH were included. Costs were in Brazilian real (BRL) and converted to US dollar (USD); 1 USD = 4.0943 BRL, in mid-December 2019.

RESULTS: Of all kidney transplants during the study period, 95% (25,530 procedures) were performed in the public setting corresponding to USD 260 million. Of those,12.8% were reimbursed by the SH accounting for USD 48 million. Hemodialysis was frequently performed at both SUS (72 million procedures) and SH (2.9 million procedures), with expenditure of USD 3.2 billion and USD 57.4 million, respectively. There were 6,837 pre-kidney and 1,858,426 post-kidney transplant care consultations in SUS, in contrast to 8,548 post-kidney transplant follow-up consultations in SH. Less than 10% (181,641) of the post-kidney transplant follow-ups were reimbursed by SH.

CONCLUSIONS: RRT represents a burden for the Brazilian health system, particularly for the public sector where the total costs of kidney transplant corresponded to around USD 260 million over the 5-year analyzed period. Although some resources were not originally used in private health facilities, SH paid SUS for RRT care approximately USD 48 million over the analyzed period.