Dialysis Moonshot Revisited: A Funding Idea

In the July/August 2019 issue of Nephrology Times¹ I published an article on the idea of a dialysis moonshot, based on the Obama/Biden cancer initiative the “Beau Biden Cancer Moonshot.”  Ryan Murray and Molly O’Neill followed up on my article by writing in the Kidney News² on behalf of the ASN about the importance of a “Kidney Moonshot” and this has been more recently reinforced by both John Sedor, who chairs the steering committee for KidneyX³, and John Butler, chair of Kidney Care Partners and CEO of Akebia Therapeutics.⁴ So the idea has some legs.

The basic point that I made was as follows:

“What the dialysis world needs is a “shot in the arm.” It needs the equivalent of the Cancer Moonshot, a $1.8 billion initiative approved in December 2016 to find a cure for cancer. The Dialysis Moonshot could focus on strategies to improve the quality of life and clinical outcomes in dialysis patients. A focused effort that is well funded could make the difference.”

Still, how to fund the initiative has not been resolved.

In an article in the June issue of the Journal of the American Society of Nephrology, Tom Hostetter proposes a novel and potentially workable idea.⁵ The premise for his funding proposal is that the large dialysis organizations—Fresenius and DaVita—in aggregate generate over $4 billion in annual profits. Yet, they seem to spend little on research. Of the money that is allocated, most is restricted to funding research ideas that are generated locally by dialysis clinics in their network.

Hostetter proposes that the government assess the dialysis chains and charge a fee of $3.00 for each dialysis treatment reimbursed by a commercial payor and $0.50 for each treatment paid by Medicare. He estimates that this would generate more than $58 million/year.

What could be done with this money? Hostetter proposes that at least one possible model is the Patient-Centered Outcomes Research Institute (PCORI). PCORI has well-established procedures to review proposals that include a diverse panel of patients, their advocates, experts, researchers in the field, and commercial entities.

Dialysis does need a shot in the arm in funding. The federal government spends a fraction of money on kidney disease compared to what it spends on cancer, cardiovascular, or HIV research.⁶ Increases in kidney funding especially earmarked for dialysis have been quite modest, at least to date, and have not led to any meaningful innovation in dialysis care. The status quo is unacceptable.

Therefore, identifying an alternative source of funding is welcome and needed. That it comes from a small assessment on commercial and Medicare reimbursed treatments is reasonable. Still, expect the dialysis providers and their shareholders to push back. They will view it as a burdensome tax. But they have had their chance to spend money on research and improve outcomes. Progress has been spotty.

Tom Hostetter should be applauded for coming up with an innovative idea that might have a transformative effect on outcomes in dialysis patients. It’s the right thing to do.

Follow me on Twitter @DoctorAjaySingh

References

1. Singh AK: Time for a Dialysis Moonshot Neph Times, Aug 23, 2019. https://www.docwirenews.com/latest-nephrology-news/time-for-a-dialysis-moon-shot/
2. Murray R The Kidney Moonshot. Kidney News October/November 2019 (Vol. 11, Number 10 & 11) https://www.kidneynews.org/kidney-news/current-issue/the-kidney-moonshot
3. Neumann ME: Kidney community needs to embrace “moonshot” from Advancing American Kidney Health, Kidney Nephrology News and Issues. March 8, 2020. https://www.healio.com/news/nephrology/20200308/kidney-community-needs-to-embrace-moonshot-from-advancing-american-kidney-health-kidneyx
4. Butler JP: A kidney disease moonshot is long overdue. The Hill. https://thehill.com/blogs/congress-blog/healthcare/488656-a-kidney-disease-moonshot-is-long-overdue
5. Hostetter TH: A Modest Proposal to Spur Innovation in Chronic Dialysis Care. JASN. 2020;31(6): https://jasn.asnjournals.org/content/early/2020/06/18/ASN.2020020138
6. Mendu ML, Erickson KF, Hostetter TH, et al. Federal Funding for Kidney Disease Research: A Missed Opportunity. Am J Public Health. 2016;106(3):406-407. doi:10.2105/AJPH.2015.303009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815960/