The Economics Behind Dialyzers

Reuse vs. Single-Use

There are benefits to both single-use and reuse dialyzers, and each clinic needs to make the best decision for its own setting based on its structure and staffing model, said Rasin and Bosch.

“There are four categories you should use to evaluate reusable versus single-use dialyzers: efficacy, economics, environment and effort,” said Chris Gustilo, marketing manager at Minntech Renal Systems. “In terms of efficacy, reusable and single-use dialyzers have been compared extensively over the past 20 years. The overall outcome from these studies does not favor either single-use or dialyzing using a reprocessed dialyzer, and any differences in efficacy are not statistically significant.”

However, he added, using the “economic lens,” the reuse of dialyzers continues to have a significant and positive financial impact for dialysis clinics. “A comprehensive analysis that takes into account all of the costs of a dialysis treatment will show that a clinic with 10 patients or more will be beneficially impacted by the reuse of dialyzers,” Gustilo stated. “But the area where reuse provides the greatest benefit is the impact on the environment. From the latest USRDS report, there are approximately 400,000 hemodialysis patients undergoing 61,200,000 treatments annually in the United States. If every treatment used a single-use dialyzer, landfills would be filled with 61,200,000 dialyzers per year. In contrast, if every treatment used a reusable dialyzer that averaged 15 reuses, a total of 4,080,000 dialyzers would be used annually. This is a difference of 57,120,000 dialyzers. Centers that reprocess dialyzers in general realize a savings of $4-$6 per treatment. Using the conservative $4 figure, this represents a savings of more than a quarter of a billion dollars annually! With each dialyzer weighing over a pound, the amount of waste is over 57 million pounds per year.”

But some people are concerned about the work involved with running a good reuse program. “This concern is not unfounded,” Gustilo acknowledged. “Maintaining a good dialyzer program requires paying attention to detail, training staff adequately, using automated equipment and assessing reuse outcomes on a continual basis. However, these requirements are not unique to reuse, but an integral component of managing a safe and efficient dialysis program. The key is keeping the entire dialysis process under control, which includes reuse. Some dialysis organizations have established central dialyzer reprocessing centers—central reprocessing facilities that serve multiple dialysis centers. The reprocessed dialyzers are then returned to these same centers for subsequent use. This arrangement allows the dialysis organization to maintain the cost, efficacy and environmental benefits of reuse, and, at the same time, centralize the management of the reuse program in order to optimize reuse program operations,” he said.

Prichard countered, however, that the medical community in the United States and abroad seems to be trending toward the use of single-use dialyzers, in part because of an increased appreciation for biocompatibility, and in part due to capacity expansion in the market, driving pricing down. “Prices of the single-use dialyzers have been driven down to the degree that price is less of a factor than it used to be, particularly when physicians consider that patient risk is decreased and manufacturers can ensure the product is safe through sterilization processes such as oxygen-free gamma irradiation,” she said. “At Baxter, we are experiencing a very high demand for our newest single-use, high-flux, synthetic dialyzer, Xenium, which has exceptional middle -molecule clearance. We are presently working on developments that will offer additional performance advantages for our customers.”