Abstract
BackgroundThe nature of cost-saving effects of early referral to a nephrologist in patients with chronic kidney disease (CKD) is not fully evaluated. We evaluated the health care costs before and after dialysis according to the referral time.MethodsA total of 879 patients who were newly diagnosed as having end-stage renal disease from August 2008 to June 2011 were prospectively enrolled. The early referral (ER) group was defined as patients who were referred to a nephrologist more than a year before dialysis and had visited a nephrology clinic 2 or more times. Patients whose referral time was less than a year were considered the late referral (LR) group. Information about medical costs was acquired from the claim data of the Korea Health Insurance Review and Assessment Service.ResultsThe total medical costs during the first 12 months after the initiation of dialysis were not different between the 526 ER patients and the 353 LR patients. However, the costs of the ER patients during the first month were significantly lower than those of the LR patients (ER vs. LR: 3029±2219 vs. 3438±2821 US dollars [USD], P = 0.025). The total 12-month health care costs before the initiation of dialysis were significantly lower in the ER group (ER vs. LR: 6206±5873 vs. 8610±7820 USD, P<0.001). In the multivariate analysis, ER significantly lowered the health care costs during the 12 months before (2534.0±436.2 USD, P<0.001) and the first month (428.5±172.3 USD, P = 0.013) after the initiation of dialysis.ConclusionsThe ER of patients with CKD to a nephrologist is associated with decreased medical costs during the pretreatment period of renal replacement therapy and the early period of dialysis initiation.
Highlights
Chronic kidney disease (CKD) is a major public health problem that is continually growing worldwide
Of the 879 patients enrolled in the cost analysis, 526 patients were in the early referral (ER) group, and 353 were in the late referral (LR) group
The total 12-month health care costs before the initiation of dialysis were significantly lower in the ER group (ER vs. LR: 620665873 vs. 861067820 USD, P,0.001)
Summary
Chronic kidney disease (CKD) is a major public health problem that is continually growing worldwide. In the United States, the prevalence estimate for CKD rose from 12.3% to 14.0% over the past 20 years [4]. Kidney function progressively declines in a proportion of CKD patients without adequate therapy, eventually progressing to devastating end-stage renal disease (ESRD) [5]. The total treated ESRD population in the United States rose from 450,000 in 2004 to 593,086 in 2010 [4]. In Korea, the overall number of ESRD patients was 56,396, and the prevalence was 738.3 per million population, at the end of 2009 [6]. The nature of cost-saving effects of early referral to a nephrologist in patients with chronic kidney disease (CKD) is not fully evaluated. We evaluated the health care costs before and after dialysis according to the referral time
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