Economic Assessment of Treatment of Glomerulonephritis in Bulgaria

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Economic Assessment of Treatment of
Glomerulonephritis in Bulgaria

• Jasmine Pavlova,
• Tsvetelina Petrova-Gotova, Boriana Delijska,
  Valentin Lazarov, Lora Afanasieva

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• Kidney diseases are frequent, hazardous and
  curable if they are diagnosed on time. According
  to National Statistics every fourth Bulgarian has
  kidney disease and ill people under haemodialysis
  treatment are more than 2800. In Europe there are
  40 millions people with renal disorders and its
  expected their number will double next 10 years.

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• While death-rate from cardiovascular diseases
  in the Old Continent decreases, and it is closely
  connected with chronic kidney diseases, in
  Bulgaria this index is growing up and its peak
  is imminent according to the opinion of leading
  nephrologists. Its urgent to implement direct
  medical examinations of risk groups. From the
  point of view of public health and health
  economics they are completely necessary.

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• The study was conducted on review of clinical
  records of 49 patients with chronic
  glomerulonephritis, treated in the University
  Nephrology clinic, Medical University Sofia for
  period of 1 year. The signs of observation were
  age, sex, social status, basic and concomitant
  diagnosis, number of hospitalizations, number of
  days in hospital, laboratory tests (type, number,
  cost), consultations with another specialists,
  medicines (type, number, cost) and effect from
  the treatment.

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• The purpose of the study is to make a
  cost-benefit analysis of the treatment in a
  specialized therapeutical clinic of patients with
  this diagnosis as well as to make a comparative
  analysis of different approaches for treatment of
  glomerulonephritis conservative treatment,
  haemodialysis and kidney transplantation.

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• There are three basic approaches for money
  evaluation of health effects human capital
  overt preferences and determinate choice for
  willingness to pay (assessment of contingent
  costs). The implementation of health programs may
  be considered as investment in personal human
  capital.

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• Measuring of the period of return of the
  primary investment the cost of the produced time
  in health can be qualified as restored people or
  increased production on the market. Therefore the
  method of human capital place monetary weights to
  time in health, using market level of salaries
  and the cost of the program is assessed from the
  point of view of the recent value for future
  incomes.

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•         The average age of the inquired people
  was 42,3515,92 years, 57 were men, 43 - women.
  
• At the next table is shown the distribution of
  patients by sex and diagnosis.

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Patients by sex and diagnosis
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• Patients with Chronic nephritis syndrom -
  diffusion mesangioprolipheratious
  glomerulonephritis are 36,73, in the second
  place are patients with Chronic nephritis syndrom
  - insignificant glomerular violation 24,49.

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• Analyzing the allocation by age we find that
  78 are in active labor age between 21 and 60
  years. Thats why the early diagnosis and
  treatment of this disease have an important
  dimension from medical, economic, social and of
  course personal point of view.

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Patients by age and basic diagnosis
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• The number of hospitalizations for the studied
  period was 4 /-1 - from 1 to 7 entrances. It
  depends on the clinical activity and morphology
  of the glomerulonephritis and the effect of the
  treatment. The average hospital stay is 6 - 8
  days, the longest is for patients with Chronic
  nephritis syndrom - diffusion semilunar
  glomerulonephritis 8,77 days, and the shortest
  for patients with Other defined
  tubulointerstitial injuries of kidney 4,5
  days.
• Studied patients suffer from attendant
  diseases. In the first place are arterial
  hypertonia and chronic kidney insufficiency.

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• The average number of tests per person is 71
  for the studied period. Their average cost is 173
  Euro per person. For patients under 40 years the
  average number of tests was smaller - 64, for
  those over 40 years, was 76, without statistical
  significance (?gt0,05). Biopsy was made to every
  patient for confirmation of the diagnosis. The
  number of consultation with other specialists is
  relatively small due to the specificity of the
  disease 1.4 per person. The cost of the drugs
  is 108 Euro per patient.

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• The average cost of the treatment of one
  patient amount to 1463 Euro for an year, for 3,35
  hospitalization per person yearly, the cost of 1
  hospitalization is 439 Euro. The treatment of
  patients is financed by the National Health
  Insurance Fund on the basis of clinical pathways
  and is fixed on 400 Euro, that is to say we have
  not enough money for treatment. Tests represent
  11,77 of total cost of treatment, drugs 7,35
  , payment of medical specialists 45,23 , the
  rest 35,63 are for overhead costs, food,
  external services, others.

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• We report on positive effect of the treatment
  among 70 of the patients. After this they are
  with restored working capacity.
• We have studied the losses of the individuals and
  the whole society in consequence of the disease.
  Every patient miss on the average of 63 days work
  (hospital stay and temporary disability). This
  represents nearly 1026 Euro (according to
  prognosis data Gross Domestic Product per
  person of the active population).

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• Therefore total costs for 1 year treatment and
  temporary disability constitute 2513 Euro per
  patient. Comparing these results with the cost of
  treatment with haemodialysis or kidney
  transplantation (according to different studies
  in Bulgaria) we report that competent treatment
  in due time of glomerulonephritis in nephrology
  clinic is inexpensive many times. We have to add
  the poor quality of life of the patient, the
  anxiety of the ill person and his relatives to
  these mathematic calculations.

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COST OF THREE APPROACHES FOR TREATMENT OF
GLOMERULONEPHRITIS (1 YEAR)
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• Currently 27 of patients on haemodialysis are
  with primary diagnosis glomerulonephritis. Nearly
  60 from people with glomerulonephritis reach to
  chronic kidney insufficiency and haemodialysis.
  The reasons are multiple poor health culture,
  lack of medical check-up, inadequate treatment,
  negligence on the part of the patient, and not in
  the last place the poor life standard. Applying
  effective treatment up to 85 of ill people are
  in remission and have a good quality of life.

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• CONCLUSIONS
• Patients with chronic kidney diseases, especially
  the studied group with chronic glomerulonephritis
  are in young active work age
• During the first year after diagnosing the
  disease we report on high number of
  hospitalizations, with significant economic
  losses from hospital stay and temporary
  disability

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• The cost of clinical tests, treatment and the
  number of consultations depends on the
  morphologic diagnosis and its burden
• The settled data determine the chronic
  glomerulonephritis as social-significant disease
  with high cost for the patient as well as for the
  whole society

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• The therapeutical treatment of these diseases is
  many times inexpensive than heamodialysis and
  kidney transplantation
• The efforts of specialists in nephrology and
  public health have to be orientated to promotion
  and prevention of population health as well as
  to focused activities for professional
  qualification of general practitioners for
  competent and adequate actions in case of
  glomerulonephritis.

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THANK YOU FOR YOUR ATTENTION!