Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan: A combined survey and retrospective cohort analysis

Chao Hsiun Tang, Yu Ting Wu, Siao Yuan Huang, Hsi Hsien Chen, Ming Ju Wu, Bang Gee Hsu, Jer Chia Tsai, Tso Hsiao Chen, Yuh Mou Sue

Research output: Contribution to journalReview article

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Abstract

Objectives Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. Design and setting A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. Outcome measures The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. Results The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. Conclusions APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.

Original languageEnglish
Article numbere015067
JournalBMJ Open
Volume7
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

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Continuous Ambulatory Peritoneal Dialysis
Taiwan
Cohort Studies
Economics
National Health Programs
Costs and Cost Analysis
Peritoneal Dialysis
Health Expenditures
Dialysis
Quality of Life
Surveys and Questionnaires
Propensity Score
Multicenter Studies
Motivation
Outcome Assessment (Health Care)
Databases
Interviews

Keywords

  • economic cost
  • medical utilization
  • peritoneal dialysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan : A combined survey and retrospective cohort analysis. / Tang, Chao Hsiun; Wu, Yu Ting; Huang, Siao Yuan; Chen, Hsi Hsien; Wu, Ming Ju; Hsu, Bang Gee; Tsai, Jer Chia; Chen, Tso Hsiao; Sue, Yuh Mou.

In: BMJ Open, Vol. 7, No. 3, e015067, 01.03.2017.

Research output: Contribution to journalReview article

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abstract = "Objectives Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. Design and setting A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. Outcome measures The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. Results The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. Conclusions APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.",
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T1 - Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan

T2 - A combined survey and retrospective cohort analysis

AU - Tang, Chao Hsiun

AU - Wu, Yu Ting

AU - Huang, Siao Yuan

AU - Chen, Hsi Hsien

AU - Wu, Ming Ju

AU - Hsu, Bang Gee

AU - Tsai, Jer Chia

AU - Chen, Tso Hsiao

AU - Sue, Yuh Mou

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objectives Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. Design and setting A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. Outcome measures The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. Results The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. Conclusions APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.

AB - Objectives Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. Design and setting A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. Outcome measures The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. Results The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. Conclusions APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.

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KW - medical utilization

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