Cost of haemodialysis portable machines

Can anyone tell me what the purchase price is of a good haemodialysis portable machine. I have read about the Allient and the NxStage one.
Is the Aksys PHD PORTABLE available yet to purchase. What are the cost of the consumables relative to the different machines. Does anyone know if the consumables are readily available in South Africa.
Heather

The Allient hasn’t been FDA approved for sale in the US yet. To the best of my knowledge trials for home use haven’t been started yet.

I’d say a brand new NxStage System One costs between $15,000 - $25,000…without supplies…

I was told the NxStage is up to $42,000, I’d love to know for sure.

Cathy

Wow!
Call me ignorant but do you guys have to pay for these or are they covered by government and /or private health cover? :shock:

We have quite a bit of information on Medicare coverage of home dialysis at http://www.homedialysis.org/v1/medicare/. We don’t have information on commercial coverage of home dialysis because that varies from plan to plan. Your policy and plan customer service should be able to explain coverage.

In the U.S. no one needs to buy a dialysis machine to do home dialysis. I suspect that very few people have purchased their home hemo machine. Part of the reason why it might not be the best thing to do even if you have the money is that you’d be stuck with that machine when new machines come out.

In South Africa, the situation is that a patient has to be assessed as to whether he/she is a candidate for a transplant. If they are not a candidate for a kidney transplant the general hospitals give you 2 weeks notice that they will no longer continue with dialysis. This means that you have to find your own funding or seek financial assistance from your own medical aid, and full costs are not covered.
From one response it seems that purchasing a machine may not be a good idea. Does anyone know if NxStage one is available in South Africa for rent, and who the suppliers are?
Heather

Boy, I didn’t know that the health system in S Africa only pays for dialysis if you are a candidate for a transplant. I’ll remember that the next time I’m unhappy with how the U.S. government pays for care. Do the hospitals in S Africa have social workers to help you find other funding? In the U.S. there are social workers in hospitals and in dialysis clinics and transplant programs.

I would kind of be surprised if NxStage is selling or renting machines outside the U.S. at this point, but you could email them from the contact us email form on http://www.nxstage.com.

There are companies that sell refurbished dialysis equipment that they have bought from clinics that upgraded or for some reason don’t need those machines now. If funding is an issue this might be something to consider. G.I.A. Medical at http://www.giamedical.com and Wil-Med at http://www.wilmedglobal.com/ are two companies that I’ve heard of that do this.

Peritoneal dialysis may be cheaper – and possibly easier to do with the shorter training time and no need for changes to the home for plumbing or electrical work or having a water treatment system. You can do PD manually (CAPD) or with a machine (CCPD or APD). CAPD in the U.S. costs clinics less because it doesn’t require a machine.

I found a fee schedule on the Dept of Health website for S Africa for those that private pay and it looks like PD may be cheaper. The question is whether the amount listed is per day for PD as it is per session for HD.
http://www.doh.gov.za/programmes/upfs/docs/2005/tariffs-full.pdf

Thansks for your response Beth. Will look up the website that you gave me. Unfortunately my sister is not a candidate for peritoneal dyalysis as she has had a lot of abdominal surgery. The social workers here do not help with finding funding. You are very much on your own here.
I contacted Adcock Ingram in South Africa. They offer the Tina hemodialysis machine for home use, but it costs in the region of R13,000 to R15,000 to put in a purified water system into the house. As my sister is only renting and I’m hoping to bring her down to Cape Town at the end of the year, the cost just does not seem to be worth it for such a short period. Do you know which other hemodialysis machines do not need the installation of a purified water system?

My goodness, I also was not a good candidate for PD…

Have you tried contacting NxStage with your situation? I wonder whether NxStage would be kind enough to expand their market in other countries…

Hi Gus, Just heard now that my sister is not a candidate for kidney transplant and the hospital want to stop offering dialysis now. Can you believe it. Trying to frantically find an alternative clinic to continue for the time being. I believe that NxStage is not in South Africa and I’m concerned about what consumables I need and how easy it will be to order these. I don’t even know what consumables I need, who will do the servicing of the machine, what technical back up there is in South Africa. All sounds so jolly difficult when you know nothing about this area.

Am really sorry to hear that…time is critical and it seems time is running out, but I think your whole family needs to make some very difficult choices, try spending more time with your sister.

I hope and wish NxStage is reading this…I think they can be a life saver with their machine that doesn’t require so much resources…“NxStage, are you listening? Show the whole world how your little machine can save people’s lives in other countries like Africa…”

Thanks Gus, let’s hope NxStage is listening to a call from Africa, - I feel rather desperate. I’m a long way from my sister - she has just moved to Johannesburg and myself and the rest of the family are in Cape Town. Once she has settled a little, we will try to get her back to Cape Town where she can have family support. Right now she is very tearful, and doesn’t want to continue with life. She’s had such a hard 3 weeks. Do you know that she was referred to the Johannesburg Hospital as an emergency patient with suspected kidney stones in her one 80% functioning kidney (the othe one was lost a few years ago). She got to the hospital at 10.30am and she was finally seen by a doctor at 11.30pm that night. She was due to have an angioplasty and the insertion of a stent a couple of weeks later, and justs before she went into theatre the operation was cancelled - sorry we have run out of supplies of stents. We’ll try another day. All of this has been very exhausting and painful. So much for our health system.
Heather

Its very sad and depressing, to all of us…

I’ve read how life can be so hard in countries like Africa…just about every part in this world there’s pain and suffering. We’re not alone…we all have our share of problems, but there’s one thing we all can do and that’s show compassion to those who suffer more.

If your a religious person, your community parish can also step in and give spiritual support in difficult times. Things like that help get through the process.

I rememeber, close relatives who had cancer and they struggled hard, the desperation, the financial dificulty and all that goes with it…to the end how exhausted we’d end up, but we tried.

In moments like this, its best to spend more time with sister, give her all the support and peace she can get.

Our prayer intentions for this week will be made out to your sister and your whole family…

I was in South Africa in 1999 and dialyzed through private clinics that served self-pay clients. This is from mytrip report:

I set up the treatments in Africa over the Internet through Ted Pope, who operates several private dialysis units. I dialyzed at his Port Elizabeth and Nelspruit units. Mr. Pope also arranged my dialysis at a private unit in the Capetown area. I would return to South Africa tomorrow, if I have the opportunity. The units may use a mix of machines, lack TVs, and you need to bring your own Epogen and Calcijex, but the dialysis is just as effective as anywhere else.

The dialysis units that I visited accommodated just two to four patients at a time. South Africa’s public medical system is under a great deal of stress; their public dialysis facilities are at or above capacity. This makes scheduling a treatment difficult. For this reason alone, the private facilities are a good alternative. The private facilities allow you to schedule treatments in advance so that you can plan activities, flights, and car rentals with confidence. Private units are also generally cheaper. The units I dialyzed at charge under $200 U.S. each treatment.

I paid for my treatment in U.S. dollars and was reimbursed by my private insurance (Medicare does not pay for dialysis outside the U.S.). However, Mr. Pope mentioned that he would be willing to put together a package for uninsured dialysis patients traveling to South Africa. At the current exchange rate for South African Rands, dialysis would cost under $400 a week (three treatments). That compares to $1,300 and up in Europe for a week on dialysis.

Have you looked into establishing a long term relationship with one of the private units? At least as a bridge until you can establish a more sustainable strategy if $20,000 a year US is too much?

More info about my time in South Africa (including pictures) is available on the globaldialysis travel blog look at the dates November 16, 2005 - November 23, 2005.

Hi Bill, Thank you for your information. I live in South Africa, and would appreciate contact details of Ted Pope. Can you help?
Heather

I found his address then I did a Google search and came up with this site:
http://www.ewpope.co.za/

Looks like this could be just what you’re looking for - I’d be interested in hearing an update whenever you get a chance. Let us know what you’re finding out, how’s it going, etc.

I would love to go back to S. Africa tomorrow. Looking at their facilities map it looks like they’ve added a few new options since I was there over 6 years ago. Also I am sure just as when I was there Mr. Pope has contacts with other providers - for instance the Capetown area (I dialyzed in Durbanville).

Hmmmm - I’m going to go check flight prices to Capetown now - you’ve got me all worked up Heather. How’s the Safari weather this time of year?

Hi Bill, Weather in South Africa at present is very warm - 30 degrees forecast for Cape Town today. We’ve had a very windy summer which has not been pleasant. Thank you for the contact details of Ted Pope - will try to contact him and see what the charges are per dialysis treatment session. Medical aid, if they cover the costs of dialysis (I’ve not had confirmation as yet) only cover R700 per session. As most private clinics seem to charge over a R1,000, this leaves a shortfall of R300 per session which amounts to about R3,600 per month. My sister’s husband has just joined the ministery as a trainee, and only gets R1,200 per month, so obviously this will just not be possible. But will make enquiries and see what I can find out.
What I have managed to establish is that if you do not meet the State hospitals criteria for dialysis, the medical aids, use the same criteria to decide whether they will cover the cost of dialysis, but they can use their discretion as to whether they will pay, and how much they will pay. In addition to put in a fistula costs in the region of R10,000 which medical aid does not cover. I am trying to get the hospital to do this for her.
It is really a nightmare going through all these procedures.
Heather

Marty,
I don’t know where you are getting your information about the Allient System, but the system was FDA approved last June for general use. We are setting up home dialysis accounts to do a safety test for home use and are expected to start soon.

I requested info from Allient via e-mail. I had a representive call me. I specifically asked the question…How are you going to service the machines?
Will it be like NxStage where they are shipped another machine or will there be service reps. This was when I was told home trials hadn’t been started,
there were software glitches to be worked out, and they were going to try to make the machine smaller for home use. The also asked if I would like a 3 month update and I said yes. The next time they call, I will write down the names. By your post it doesn’t sound as if they have started any trials for home patients yet is this true? It sounds as though they are just looking for places (accounts) to do the trial. Or am I misinterpreting what you are saying? Didn’t know you could get FDA approval without 1st doing the trials my error. Would you think it possible the Allient would be available for use this year?