Economies of Scale and Economies of Scope of Renal Replacement Therapy in Thailand: a Scoping Review

Abstract

In 2022, Thailand revised its kidney replacement therapy policy to permit any appropriate method, shifting from a prior emphasis on peritoneal dialysis as the primary option. This policy changes significantly improved patient access to Kidney Replacement Therapy (KRT). To optimize service delivery, the unit cost, economies of scale, and economies of scope for KRT services should be determined. However, a literature review found no existing studies on this topic. To fill this gap, a scoping review was conducted to examine the unit cost of KRT in Thailand. Searches of the Thai Journals Online, MEDLINE, and Thai Digital Collection (TDC) databases identified 10 relevant studies. The review, adjusting costs to 2023 values, revealed that the unit cost of Peritoneal Dialysis (PD) ranged from 1,261 to 1,324 baht, while the unit cost of Hemodialysis (HD) ranged from 1,237 to 6,130 baht. The analysis suggests that HD may benefit from economies of scale when serving 50 or more patients, though no conclusions could be drawn about economies of scope. Additionally, the review highlighted deficiency in quality of unit cost studies on KRT in Thailand, including a lack of sensitivity analysis, comparison among patient subgroups, and consideration of indirect costs or resource specification. As a result, current unit cost data are insufficient for policymaking. Future research should focus on unit cost studies of KRT, especially among private sector providers, to enhance service efficiency and health system design.