- To establish the most cost-effective mix of resources that would support dialysis therapy for End Stage Renal Disease in Europe,
- To develop protocols for improving the quality of such dialysis services throughout Europe.
European member states spend different proportions of their Gross Domestic Product on health and different amounts of resource on specific services. There is an urgent need to measure the quality and cost of health care interventions in different European countries particularly in resource intensive areas. Dialysis is one of the most expensive treatments in medical practice and without it or a kidney transplant, patients with end stage renal disease (ESRD) will die. Dialysis technology is now advanced and safe and older patients with comorbid illnesses can be successfully treated. The number treated is rising rapidly (threefold since 1980) as the population ages in most European countries and demand grows in eastern Europe. We have found that survival in patients with ESRD was significantly influenced by comorbid illness and showed, for the first time in Europe, that even after adjusting for comorbidity and age there remained significant differences in patient survival among centres. Despite such evidence it is unclear how resources for dialysis can be deployed most cost-effectively to achieve optimal outcomes at least cost. The aim of this reinforced concerted action is to establish the most cost-effective mix of resources that would support dialysis therapy in Europe. As a result we shall develop protocols for improving the quality of dialysis services throughout Europe.
The following objectives will allow us to achieve this aim:
1. To compare the nature, volume and costs of the resources devoted to the provision of chronic dialysis treatment in different centres in Europe;
2. To establish how the resources are used in the context of the financing and planning systems of the member states taking part;
3. To measure health outcomes, using quality of life profiles and standard clinical quality indices both corrected for casemix;
4. To quantify the relationship of the resources and costs for chronic dialysis with the patient outcomes, corrected for casemix, in all centres;
5. To model longer-term scenarios for costs, outcomes and cost effectiveness of provision for dialysis patients and explore the policy potential for improvements in quality of care and determine if this can be achieved at lower cost;
6. To develop strategies and protocols for improved practice in the participating centres following discussion by the participants of the analysed data;
7. To disseminate this information to improve practice in Europe through publications, workshops and presentations; briefing papers will be prepared for health policy makers in the respective countries.
The "European added value" of such work will stem from sharing experiences in different countries thus promoting improved practice in Europe at the lowest cost possible. Our multi-disciplinary team of health economists and clinicians (medical and nursing) will work to develop robust methods for such analyses. Participating centres have either expertise in health economics or a proven interest in and ability to perform outcomes research in ESRD. The output of this reinforced concerted action will be the development of health economics methodologies and protocols for improved quality of care for chronic dialysis patients in Europe.
Keywords: Cost-effectiveness, dialysis, outcome assessment, European Community, operational modelling. 01 01