Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals

Lima, Antônio Fernandes Costa

doi:10.1590/1518-8345.1812.2944

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 26 • 2018 • https://doi.org/10.1590/1518-8345.1812.2944 copy

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals¹ 1 Paper extracted from Free Lectureship Thesis “Direct cost of conventional hemodialysis performed by nursing professionals in teaching hospitals”, presented to Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals.

Method:

quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications.

Results:

the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the “installation and removal of hemodialysis fistula access” caused a significantly lower economic impact compared to “installation and removal of hemodialysis catheter access”.

Conclusion:

with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

Descriptors:
Hemodialysis Units, Hospital; Nephrology Nursing; Costs and Cost Analysis; Cost Control

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Antônio Fernandes Costa Lima Universidade de São Paulo. Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 Bairro: Cerqueira César CEP: 05403-000, São Paulo, SP, Brasil E-mail: tonifer@usp.br

Observations	Hospital	n	Mean	sd*	Minimum-maximum	95% CI†		P-value^‡	Post hoc
Personal cost	A	312	0.19	0.12	0.12-0.71	0.17	0.18	<0.001	a
(US$)^§	B	202	0.25	0.09	0.21-0.47	0.21	0.21		b
	C	100	0.68	0.27	0.38-1.15	0.58	0.78		c
Material cost	A	312	12.47	8.36	3.16-24.41	10.72	14.31	<0.001	a
(US$)^§	B	202	24.10	0.07	24.03-24.56	24.03	24.03		b
	C	100	10.04	8.72	0.83-37.10	6.78	9.18		c
Solutions/	A	312	9.54	0.39	8.85-9.76	9.76	9.76	<0.001	a
medications costs	B	202	8.25	0.00	8.25-8.25				b
(US$)^§	C	100	9.58	0.45	9.45-11.16	9.45	9.45		c
Total cost	A	312	22.20	8.06	13.24-34.73	20.60	24.00	<0.001	a
(US$)^§	B	202	32.60	0.12	32.50-33.00	32.50	32.56		b
	C	100	20.30	8.80	11.10-48.62	16.95	19.58		c

Observations	Hospital	n	Mean	sd*	Minimum-maximum	95% CI^†		P-value^‡	Post hoc
Personal cost	A	233	0.18	0.08	0.12-0.59	0.18	0.18	<0.001	a
(US$)^§	B	26	0.46	0.09	0.47-0.69	0.47	0.47		b
	C	25	0.78	0.00	0.78-0.78				c
Material cost	A	233	1.42	0.16	1.28-2.37	1.37	1.41	0.039	a
(US$)^§	B	26	1.54	0.45	0.89-2.84	1.34	1.70		a
	C	25	2.10	0.91	0.23-2.75	1.93	2.75		b
Solutions/	A	233	0.84	0.34	0.24-2.68	0.73	0.89	<0.001	a
medications costs	B	26	2.20	1.89	0.17-7.72	1.05	2.74		b
(US$)^§	C	25	0.79	0.36	0.10-1.10	0.60	0.10		a
Total cost	A	233	2.44	0.41	1.68-4.21	2.35	2.44	<0.001	a
(US$)^§	B	26	4.20	2.0	4,17-10.53	3.11	4.73		b
	C	25	3.67	115	2.00-4.50	3.24	4.50		b

Observations	Hospital	n	Mean	sd*	Minimum-maximum	95% CI^†		P-value^‡	Post hoc
Personal cost	A	98	0.15	0.09	0.12-0.59	0.12	0.12	<.001	a
(US$)^§	B	167	0.25	0.11	0.21-0.68	0.21	0.21		b
	C	108	0.88	0.35	0.38-1.92	0.77	20.96		c
Material cost	A	98	2.56	2.93	0.63-9.37	1.18	1.71	<0.001	a
(US$)^§	B	167	1.52	1.07	0.62-9.78	1.26	1.42		a
	C	108	4.41	4.36	0.90-212.28	2.09	6.00		b
Solutions/	A	98	2.07	7.48	0.13-44.64	0.73	0.89	<0.001	a
medications costs	B	167	2.36	0.72	0.12-4.22	5.13	5.57		b
(US$)^§	C	108	2.20	0.14	1.972.39	2.19	2.23		c
Total cost	A	98	4.78	8.70	0.88-52.22	2.11	2.90	<0.001	a
(US$)^§	B	167	4.13	1.37	0.95-13.87	3.91	4.17		b
	C	108	749	4.44	3.32-15.80	5.233	9.11		c

Observations	Hospital	n	Mean	sd*	Minimum-maximum	95% CI^†		P-value^‡	Post hoc
Personal cost	A	233	0.17	0.07	0.12-0.36	0.17	0.17	<0.001	a
(US$)^‡	B	26	0.27	0.16	0.21-0.95	0.21	0.21		b
	C	25	0.72	0.23	0.38-1.54	0.58	0.77		c
Material cost	A	233	0.29	0.07	0.26-0,68	0.27	0.27	<0.001	a
(US$)^‡	B	26	0.27	0.07	0.11-0.40	0.25	0.31		b
	C	25	0.32	0.07	0.16-0.46	0.31	0.31		c
Total cost	A	233	0.46	0.10	0.38-1.03	0.44	0.44	<0.001	a
(US$)^‡	B	26	0.54	0.19	0.32-1.33	0.46	0.59		a
	C	25	1.04	0.27	0.69-2.00	0.90	1.08		b

Observations	Hospital	n	Mean	sd*	Minimum-maximum	95% CI^†		P-value^‡	Post hoc
Personal cost	A	98	0.18	0.07	0.12-0.36	0.18	0.18	<0.001	a
(US$)^§	B	167	0.23	0.07	0.21-0.47	0.21	0.21		b
	C	108	0.86	0.34	0.38-1.54	0.77	0.96		c
Material cost	A	98	0.96	1.11	0.70-11.72	0.82	0.89	<0.001	a
(US$)^§	B	167	2.36	2.92	0.31-8.18	0.75	2.47		b
	C	108	0.80	0.55	0.32-2.14	0.57	0.72		c
Solutions/	A	98	3.95	7.24	0.13-46.21	2.65	2.96	<.001	a
medications costs	B	167	1.26	1.49	0.00-6.57	1.26	2.08		b
(US$)^§	C	108	0.90	5.79	0.00-42.83	0.13	0.13		c
Total cost	A	98	5.09	7.34	0.95-47.54	3.65	4.00	<0.001	a
(US$)§	B	167	3.85	3.50	0.53-12.98	2.46	4.28		b
	C	108	2.56	5.75	0.73-43.95	1.58	1.87		c