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Chronic Kidney Disease is a serious public health problem that is increasing in incidence and prevalence as well as associated with high morbidity, mortality and costs. These costs are higher when the patient requires dialysis therapy. In Latin America (LA) it is the eighth cause of death and the tenth cause of years of life lost. A characteristic of dialysis therapies is the high level of standardization of their therapeutic protocols, which favors a more precise rationalization of the probable consumption elements (whether goods or services) necessary to provided. The objective of this study is to list all essential inputs to be considered in estimates for microcosting studies in peritoneal dialysis (PD) therapy.
To prepare the checklist, four steps were worked on, followed by data analysis and interpretation. The first three stages were carried out with the purpose of developing the direct cost elements questionnaire: the first stage designed the first version of the checklist, the second evaluated and expanded it with the application of the Delphi method, the third carried out two experts panels in adult and pediatric PD for validation. Finally, the fourth stage applied the questionnaire to professionals from 18 LA countries. Inclusion criteria: professionals should have at least one year of clinical and/or administrative experience in PD services. It was decided to limit participation to a maximum of 60 professionals and a minimum of 12 professionals per country. A discrete probability distribution adjustment was carried out, based on the responses to the questionnaires (on a Likert scale where 1 is not important and 5 is very important, with 3 being the neutrality scale). Distribution lots were considered by category of cost elements by country. The maximum likelihood estimation method was applied and the statistical classification of the adjustments was estimated using the Akaike Information Criterion, which demonstrates the binomial distribution as the most appropriate.
At the end of the application, 700 responses were collected and 596 opinion questionnaires were validated for analysis. From the results of each batch, it was possible to segment the elements into three choice options with the probability of evaluating an element as very important, thus classifying the cost elements as: permanent (p≥0.9 ), elective (0.9>p≥0.7) and unusual (p<0.7). We observed seven dimensions (professional, suplies, services, logistic of patient and caregivers, infraestructure and other professional and services) with 41 elements. Such classification does not represent some form of exclusion of the cost element, but rather an indication of its frequency, in which those unusual must receive clinical justification for their inclusion.
Despite the great differences between the health systems of the countries in LA, it was possible to draw up a sufficient checklist to be able to carry out comparative studies, especially for microcosts. We conclude that the checklist favors a more equal economic dimensioning in comparative studies, making it possible to compare economic values in PD between countries, considering cost elements appropriate to each context with their respective justifications for elective and unusual elements. We encourage the critical use of the checklist as an important support instrument for standardizing cost descriptions, favoring a more conscious decision-making environment with detailed, comparable and transparent information.