Background: Pakistan in an emerging economy where 50% of the population live below the poverty line on <$2 a day. The government spend 1.3% of GDP as health which renders 95% of the ESRD population disfranchised from RRT. Our institute developed a community government partnership where dialysis and transplantation were integrated and offered “Free with dignity” with lifelong follow-up care with medications. This paper describes economizing strategies to cater to the large population of patients.

Method: Between 1986 and 2015, 5007 living related renal transplants were performed at our center. A number of economizing strategies were employed for dialysis and transplantation to achieve economies of scale more than 700 dialysis / day and 1-2 transplants per day.

Results: Since 1986, over 5000 transplants have been performed at our centre. Dialysis was economized by using basic model of dialysis machines which are 30% cheaper, dialyzer reuse reduced cost of dialyzer from $7.0 to $0.5, in-house preparation of fluid reduced cost / session from $5 to $ 3.0. Round the clock dialysis allowed 700 patients to be dialysed daily to achieve economies of scale from $20 to $15 per session. Generic immunosuppressant reduced the cost by 30% and high volume transplants 1-2 per day reduced annual cost of care and drugs from $8000 to $5000. An annual saving of $4.8 million in dialysis and $1.5 million in transplantation. Overall 1, 5 and 10 year graft and patient survival was 95%, 85% and 70% and 97%, 88% and 78% respectively.

Conclusion: In emerging economies free dialysis and transplantation is achievable by a model where government provides infrastructure and community funds the running cost and strategies to economize without compromising quality allows more patients to receive benefit of renal replacement therapy with outcomes comparable to developed countries.

CITATION INFORMATION: Rizvi S, Zafar M, Aziz T, Hasan A, Mohsin R, Hashmi A, Hussain Z, Akhtar F, Ahmed E, Naqvi A. Strategies to Economize Dialysis and Transplantation in Low Resource Settings. Am J Transplant. 2017;17 (suppl 3).

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