Trends of Healthcare Expenditure for Early CKD and High Risk Patients in Taiwan: A Prospective Observation Study in One Teaching Hospital

Abstract

Listen

Translate article

BACKGROUND: Healthcare insurance expenditure, particularly for western medicine (WM), may be correlated to the progression of chronic kidney disease (CKD). Traditional Chinese medicine (TCM) is now frequently used in conjunction with WM for treatment of CKD in the world. Poor oral health, such as chronic inflammation and periodontal disease, has also been reported to be associated with CKD. Taiwan’s National Health Insurance (NHI) program covers WM, dentistry (DENT) and TCM services. We conducted a prospective observation study to investigate whether progressive CKD and acute deterioration of CKD are correlated with expenditures for these three services. METHODS: Participants were classified into early CKD and high risk (HR). Groups of early CKD and HR were prospectively followed up 18 months later, and categorized into deteriorated (D)-(CKD+HR) and non-deteriorated (ND)-(CKD+HR) according to the change of estimated glomerular filtration rate. Subsequently, we analyzed in retrospect the 9-year healthcare expenditures among the four groups. RESULTS: In a prospective analysis, a total of 1,397 subjects were enrolled and 1,020 subjects (including 880 patients in the early CKD group and 140 patients in the HR group) completed the 18-month follow-up. In expenditure for WM, the early CKD group had higher costs than the HR group (P ＜ 0.01); however, in DENT and TCM, there was no obvious difference between early CKD and HR (all P ＞ 0.05). Finally, group D-(CKD+HR) had no obviously higher costs than ND-(CKD+HR) among WM, DENT and TCM (all P ＞ 0.05), retrospectively. CONCLUSION: In Taiwan, early CKD patients require more total health care expenditure than HR patients. Compared with TCM and DENT, WM consumed the highest healthcare expenditure for CKD patients and the costs increased annually with progression of CKD. Acute deterioration of CKD may not have an impact on past expenditure, but progressive CKD is linked to an evident gradual increase in total insurance burden. Early prevention in CKD progression is thus an important policy for saving on costs.