The Economics Behind Dialyzers

Cost Management and Supply Chain

Regardless of whether the facility chooses single-use or reprocessed dialyzers, cost is always going to be an issue. “The most effective way to control costs of dialyzers is to assure that clinics prescribe the right-sized dialyzer for each individual patient,” Rasin and Bosch said. “We see a stable trend where providers default to prescribing the largest dialyzer for an increasing share of patients in their clinics in an effort to reduce complexity and drive toward achieving the desired clinical outcomes measured as Kt/V. The larger dialyzers are more expensive and are, with today’s membrane performance, not needed for each and every patient.”

In response to this trend, Gambro developed an interactive tool, The Kt/V Dialyzer Performance Calculator, which enables providers to enter individual patient information that yields the right-size dialyzer for that patient prescription. “This enables clinics to easily prescribe the most effective dialyzer and drive toward a balanced operation between dialyzer costs and clinical outcomes,” Rasin and Bosch observed. “Additionally, due to the advances of membrane performance, the new Polyflux Revaclear product line will be available in two sizes. Gambro has been able to refine the membrane technology to deliver optimal performance while reducing the membrane surface and the extracorporeal blood volume. This unique balance enables us to treat all patient needs with only two sizes. In addition to the benefits of reduced complexity and smaller extracorporeal volumes, the packaging of the product has also improved. Our new boxes enable clinics to stack the product while using less storage space. The Polyflux Revaclear dialyzer addresses many of the current pain points that exist today in dialysis delivery.”

Gustilo described a standard cost management model employed by centers that use single-use dialyzers. This type of program incorporates the following characteristics, he said:

• Standardize on a few models and 'guide' patients to the most inexpensive model

• Get a bundled package by purchasing the dialysis machine and then get a deal on the dialyzers from the same manufacturer (or visa versa), and

• Buy in bulk.

In general, all three of these tactics will allow centers to lower their costs, at least minimally, he said. “Still, the biggest bang for the buck for most dialysis centers, in terms of managing costs, continues to be dialyzer reprocessing. Clinics see the cost of dialyzers cut in half while maintaining efficacy. In fact, efficacy can potentially be even better since the clinic is able to ‘right-fit’ dialyzers—choosing the absolute best reusable dialyzer for the patient based on the patient needs and not the best deal. All of this aside, my largest concern is with future dialyzer pricing. We know that oil has gone from $60 to over $135 per barrel. We also know that dialyzers are made from 99 percent petroleum-based products. However, we have not yet seen any dialyzer price increases. This is not sustainable, especially as margins for the other products manufactured by dialyzer manufacturers being pressured downward. When these price increases take place, dialysis organizations will feel it directly to their bottom line. (As a point of reference, single-use dialyzers account for 5 percent to 10 percent of the cost of doing dialysis.),” he added.

“One last comment I have on this question regards the competitive landscape and the near monopoly the largest suppliers have in the dialysis market. The pharmaceutical, dialysis-specific supply and equipment companies have near monopolies. Given this advantage, major suppliers are able to increase costs at the expense of providers. This has been a routine occurrence in the supply chain for ESAs and will continue to occur as dialysis supply organizations use ‘bundling’ to further drive out competition,” said Gustilo.

As the industry continues to improve the clearance of dialyzers, therapy is becoming more effective and more efficient, Prichard said. “The biocompatibility trend is minimizing patient reactions and complications. When a physician uses a high-efficiency dialyzer that is effective and does not invoke a reaction in the patient, they are able to move patients in and out of their clinics with little complication and increased patient volume. Prices have reached a point that physicians can now provide high quality and efficient therapy without high cost,” she added.