Chang Yu-Kang, Hsu Chih-Cheng, Chen Pei-Chun, Chen Yi-Shan, Hwang Shang-Jyh, Li Tsai-Chung, Huang Chiu-Ching, Li Chung-Yi, Sung Fung-Chang
Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Chunan, Taiwan.
Nephrology (Carlton). 2015 Apr;20(4):243-9. doi: 10.1111/nep.12380.
The prevalence of end-stage renal disease in Taiwan is among the highest in the world. Treatment reimbursement for haemodialysis was capped in 1996 in order to contain costs. This study evaluated temporal changes in the costs and utilization of medical care and mortality in patients receiving haemodialysis following capped reimbursement.
Using insurance claims data in Taiwan between 1998 to 2009, we established eight annual subcohorts of patients with incident haemodialysis, increasing from 6099 in 1998 to 7745 in 2005. With a 4-year follow-up paradigm for each subcohort, we evaluated resources use and costs of medical services, as well as mortality trends.
The annual mean cost for each haemodialysis patient increased from US $431 to $737 for emergency visits, US $9007 to $13,280 for hospitalizations and US $79,141 to $92,416 (16.8% increase) for total costs, from the initial to final subcohorts, respectively. Compared to the 1998 subcohort, the adjusted hazard ratio of deaths declined from 0.97 (95% CI 0.91 to 1.02) for the 1999 subcohort to 0.86 (95% CI 0.82 to 0.91) for the 2005 subcohort (P for trend <0.001). The corresponding cumulative probability of deaths decreased from 45.5% to 35.4%.
The mortality for patients with haemodialysis decreased annually, whereas the overall annual cost increased despite capped reimbursement for haemodialysis. These results encourage further study on reasons of increased uses of emergency service and hospitalization.
台湾地区终末期肾病的患病率位居世界前列。为控制成本，1996年对血液透析的治疗费用报销设置了上限。本研究评估了报销上限后接受血液透析患者的医疗费用、医疗服务利用情况及死亡率随时间的变化。
利用台湾地区1998年至2009年的保险理赔数据，我们建立了8个血液透析新发病例的年度亚队列，数量从1998年的6099例增加到2005年的7745例。对每个亚队列采用4年随访模式，我们评估了医疗资源的使用、医疗服务成本以及死亡率趋势。
从最初的亚队列到最后的亚队列，每位血液透析患者的年平均费用分别从急诊的431美元增至737美元、住院的9007美元增至13280美元，总费用从79141美元增至92416美元（增长16.8%）。与1998年亚队列相比，1999年亚队列死亡的调整风险比从0.97（95%可信区间0.91至1.02）降至2005年亚队列的0.86（95%可信区间0.82至0.91）（趋势P<0.001）。相应的累积死亡概率从45.5%降至35.4%。
血液透析患者的死亡率逐年下降，而尽管血液透析报销有上限，但总体年度费用仍在增加。这些结果促使进一步研究急诊服务和住院使用增加的原因。
