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
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
BMJ Open. 2017 Mar 21;7(3):e015067. doi: 10.1136/bmjopen-2016-015067.
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.
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.
The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients.
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.
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.
2005年全民健康保险（NHI）支付计划引入经济激励措施后，台湾成功提高了腹膜透析（PD）的使用比例。本研究旨在从社会角度比较自动化腹膜透析（APD）和持续性非卧床腹膜透析（CAPD）两种方式的经济成本。
从NHI研究数据库中确定了2004 - 2011年接受腹膜透析的患者回顾性队列。通过倾向得分1:1匹配了1749例APD患者和1749例CAPD患者，对其NHI资助的医疗费用和使用情况进行分析。进一步对来自台湾四个地区五家医院的117例APD患者和129例CAPD患者进行多中心面对面访谈研究，以收集他们的自付费用、生产力损失以及使用欧洲五维健康量表（EuroQol - 5D - 5L）评估的生活质量数据。
APD和CAPD患者的NHI资助医疗费用、自付费用和生产力损失。
随访5年后，APD患者每位患者每年的NHI资助医疗总费用显著高于CAPD患者（23,005美元对19,237美元；p<0.01）。在透析相关费用方面，APD因使用APD机器（795美元）和APD套装（2913美元）而费用更高。发现APD的生产力损失（2619美元）显著低于CAPD（6443美元），但自付费用无显著差异。在自助法分析中，APD和CAPD之间NHI资助医疗费用和生产力损失的差异仍然显著。即使经过自助法分析（APD为28,399美元；CAPD为27,960美元），APD的总经济成本（30,401美元）与CAPD的总经济成本（29,939美元）相似。在APD和CAPD患者的死亡率和生活质量结果方面未发现明显差异。
与CAPD相比，APD每年的透析相关费用更高，每年的生产力损失更低，这使得台湾APD的经济成本与CAPD非常接近。
