Abstract
Background: Acute kidney injury occurs when the kidneys lose their function over hours or days. If a pharmaceutical intervention is not available, renal replacement therapy can play an essential role in increasing patients’ survival chances. Currently, there are four methods of renal replacement therapy, and the preferred method will depend on patients’ disease indications. One of the methods is known as a continuous renal replacement therapy (CRRT), which is already included in the universal healthcare benefits package under the Universal Coverage Scheme, covered by the National Health Security Office (NHSO). However, from the annual’ s stakeholder meetings held by NHSO, there were comments regarding access and reimbursement for CRRT. Objective: The objective of this study was to analyze the incidence, cost, and budget implications for critically ill patients with acute kidney injury requiring CRRT. Specifically, this study included a survey to examine the feasibility to provide CRRT services among hospitals in Thailand and a costing exercise to investigate the unit costs of such services in selected hospitals. Methods: This study included analyses of NHSO's e-Claim databases to inform the incidence of renal replacement therapy usage, and a budget impact analysis was performed from the perspective of the public health insurance system in a 5-year timeframe. Furthermore, The feasibility and service resources survey was conducted by sending surveys to more than 280 hospitals nationwide. Results: The results showed that there were between 3,540 - 6,049 acute kidney injury patients requiring CRRT annually in Thailand, and the cost of CRRT was between 57,502 and 116,890 baht per person. As for the five-year budget impact analysis, If we are referring to the number of patients who need CRRT services at 3,540 will be between 1,017 and 2,068 million baht. In the other case, if referring to the number of patients at 6,049, the budget impact will be between 1,739 and 3,535 million baht. From the stakeholder consultation meetings, there appears to be inadequate support for hospitals to provide CRRT. Moreover, the survey results showed that 88% of hospitals currently providing CRRT could treat more patients if the reimbursement rate for CRRT were to be adjusted to more appropriate level. Conclusion: Information from this study could support policymakers to update reimbursement rate and associated processes in order to improve accessibility to CRRT among critically ill patients with acute renal injury.
