While patients with end-stage kidney disease have benefited from innovations in clinical
therapeutics and care delivery, these changes have been primarily incremental and
have not fundamentally transformed care delivery. Dialysis markets are highly concentrated,
which may impede innovation. Unique features of the dialysis industry that have contributed
to consolidation can help to explain links between consolidation and innovation. We
discuss these unique features and then provide a framework for considering the effects
of consolidation on innovation in dialysis that focuses on the following economic
considerations: (1) industry characteristics, composition, and stage of consolidation,
(2) innovation characteristics and relative profitability, (3) the role of government
regulation, and (4) innovation from smaller providers and new entrants. We present
examples of how these considerations have influenced the adoption of alternative dialysis
technologies such as peritoneal dialysis and erythropoietin-stimulating agents, and
we discuss how consolidated markets can both help and hinder recent policy initiatives
to transform dialysis care delivery. Only by considering these important drivers of
consolidation, future efforts can be successful in transforming end-stage kidney disease
care.
Key Words
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Article Info
Footnotes
Financial Disclosures: Dr. Erickson provides consulting services for Acumen LLC, Burlingame CA, and has received honoraria from Dialysis Clinics Inc and Satellite Dialysis. Dr. Wang reports receiving an institutional research contract from the Centers for Medicare and Medicaid Services , reviewer honoraria from the National Institutes of Health , and institutional grants from the Department of Veterans Affairs HSR&D, the Agency for Healthcare Research and Quality , the National Institute of Diabetes and Digestive and Kidney Diseases . A. Warrier declares that she has no relevant financial interests.
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