Application of an interrupted time series analysis (ITS) to evaluate the effect of universal dialysis policy from 2006 to 2016 in a province of northeastern Thailand

Abstract

Background: An interrupted time series (ITS) analysis is a powerful tool for policy evaluation. In Thailand, chronic kidney disease (CKD) is a public health problem that requires a long recovery time and has a high treatment cost. The universal coverage policy for renal replacement therapy (universal dialysis policy), is used to treat this disease but policy evaluation using ITS analysis has rarely been conducted. This study applied ITS analysis to test the effect of such a policy between 2006 and 2016. Methods: Data were retrieved from the electronic database of the health data center in Roi Et Province for the period between January 1, 2006 and December 31, 2016. 15,681 CKD stage 5 patients were included. The intervention under assessment was the universal health coverage system, which has been implemented since 2008. Results: Results showed that before implementation of the universal dialysis policy, the overall trend of access to renal replacement therapy (RRT) slightly increased (0.74; 95% confidence interval (CI): 0.58, 0.90). After implementation of the policy, access sharply increased (6.10; 95%CI: 3.67, 8.54), while the linear trend after policy implementation also slightly increased (0.29; 95%CI: 0.05, 0.14). The stratified analysis showed the same linear directional trend before and immediately after implementing the universal dialysis policy. Conclusions: Implementation of the universal dialysis policy positively impacted the rate of renal replacement therapy in CKD stage 5 patients, while access to health care services also increased.