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Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan.

ABSTRACT: OBJECTIVES:The total medical (economic) costs of haemodialysis (HD) and peritoneal dialysis (PD), including direct medical costs, out-of-pocket (OOP) costs and productivity losses, have become an important issue. This study aims to compare the direct non-medical costs and indirect medical costs of both modalities in Taiwan. DESIGN AND SETTING:This multicentre study included cross-sectional interviews of patients over 20 years old and articulate, who had been continuously receiving long-term HD or PD for more than 3?months between April 2015 and March 2016. Mann-Whitney U test, Wilcoxon rank-sum test and 1000 bootstrap procedures with replacement were used for analysis. OUTCOME MEASURES:Differences in OOP costs and productivity losses. RESULTS:There were 308 HD and 246 PD patients available for analysis. HD patients had significantly higher monthly OOP costs than PD patients after bootstrap procedures (NTD 5912 vs NTD 5225, p<0.001; NTD, new Taiwan dollars; 1 US dollar=30 NTD). Compared with PD patients, HD patients had higher monthly productivity losses after bootstrap procedures (NTD 14 150 vs NTD 11 611, p<0.001), resulting from more time spent seeking outpatient care (HD, 70.4?hours vs PD, 4.4?hours, p<0.001) and time spent by family caregivers for outpatient care (HD, 66.1?hours vs PD, 6.1?hours, p<0.001). The total costs per patient-month of HD and PD modalities, including OOP costs and productivity losses, were NTD 20 062 and NTD 16 836, respectively. CONCLUSIONS:The HD modality has higher OOP costs and productivity losses than the PD modality in Taiwan.

SUBMITTER: Tang CH

PROVIDER: S-EPMC6475228 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan.

Tang Chao-Hsiun CH Chen Hsi-Hsien HH Wu Ming-Ju MJ Hsu Bang-Gee BG Tsai Jer-Chia JC Kuo Chi-Cheng CC Lin Shih-Pi SP Chen Tso-Hsiao TH Sue Yuh-Mou YM

BMJ open 20190323 3

<h4>Objectives</h4>The total medical (economic) costs of haemodialysis (HD) and peritoneal dialysis (PD), including direct medical costs, out-of-pocket (OOP) costs and productivity losses, have become an important issue. This study aims to compare the direct non-medical costs and indirect medical costs of both modalities in Taiwan.<h4>Design and setting</h4>This multicentre study included cross-sectional interviews of patients over 20 years old and articulate, who had been continuously receiving ...[more]

PMID: 30904836

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Project description:Key Points The number of patients initiating peritoneal dialysis each year in the United States is steadily increasing. Accordingly, the number of people discontinuing peritoneal dialysis and converting to hemodialysis will likely increase in future years. The transition is defined by high rates of hospitalization and health-care spending. Outcomes after the transition remain relatively poor. Visual Abstract Background Increasing use of peritoneal dialysis (PD) will likely lead to increasing numbers of patients transitioning from PD to hemodialysis (HD). We describe the characteristics of patients who discontinued PD and converted to HD, trajectories of acute-care encounter rates and the total cost of care both before and after PD discontinuation, and the incidence of modality-related outcomes after PD discontinuation. Methods We analyzed data in the United States Renal Data System to identify patients aged ≥12 years who were newly diagnosed with ESKD in 2001–2017, initiated PD during the first year of ESKD, and discontinued PD in 2009–2018. We estimated monthly rates of hospital admissions, observation stays, emergency department encounters, and Medicare Parts A and B costs during the 12 months before and after conversion from PD to HD, and the incidence of home HD initiation, death, and kidney transplantation after conversion to in-facility HD. Results Among 232,699 patients who initiated PD, there were 124,213 patients who discontinued PD. Among them, 68,743 (55%) converted to HD. In this subgroup, monthly rates of acute-care encounters and total costs of care to Medicare sharply increased during the 6 months preceding PD discontinuation, peaking at 96.2 acute-care encounters per 100 patient-months and $20,701 per patient in the last month of PD. After conversion, rates decreased, but remained higher than before conversion. Among patients who converted to in-facility HD, the cumulative incidence of home HD initiation, death, and kidney transplantation at 24 months was 3%, 25%, and 7%, respectively. Conclusions The transition from PD to HD is characterized by high rates of acute-care encounters and health-care expenditures. Quality improvement efforts should be aimed at improving transitions and encouraging both home HD and kidney transplantation after PD discontinuation.

Dataset Information

Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan.

Publications

Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan.

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