Is Changing Modality from Peritoneal Dialysis to Hemodialysis More Economic Than Just Hemodialysis?

• Main Authors: Hsiao-Chin Chen, 陳曉瑾
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/02100813541740016076

碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === BACKGROUND The incidence and the prevalence of dialysis in Taiwan have remained in top three globally for several years. The overall expenses of dialysis have made up a considerable portion of total government health spending. The Ministry of Health Insurance has put a large amount of effort in encouraging the use of peritoneal dialysis and subsidizing the hospitals and facilities with peritoneal dialysis equipments in order to lower the overall dialysis related expense. However, the decision of choosing peritoneal dialysis or hemodialysis should be based on patient’s needs and preferences. Therefore, it is essential to find out whether the increasing usage of peritoneal dialysis will impose a positive impact on both patients and government health spending in terms of survival rate and overall medical expenses in the long run. PURPOSE The purpose of the study is to discuss the difference in the costs of outpatient services rate, emergency treatment rate, hospitalization rate, and survival rate between the patients who received just hemodialysis treatment, and those who switched from Peritoneal Dialysis to Hemodialysis. METHOD This research uses the diagnosis and therapeutics facts of dialysis treatment taken in Taiwan and analyzes the systematic sampling cohort database of National Health Insurance database from 2003 to 2006. After abstract the first set of records, and eliminate those patients who did dialysis treatments between Jan. and Jun. 2003, we have 62,381 qualified patients’ records. Then we separate these patients into P.D. switched to HD group and sole Hemodialysis group. After matching and fitting into the research, we have finalized P.D. switched HD patients: 158 and Sole Hemodialysis patients: 632. then we use “ chi-square test” and “Fisher’s exact test” to identify the differences of the gender, age, and spread of Elixhauser Comorbidity index. Uses 2 sample t-test to identify the differences of average monthly outpatient services, average cost, emergency visit, and emergency cost to gender, age between the two group and the spread of Elixhauser Comorbidity index. Then use Kaplan-Meier Curve to calculate survival rate and to see if there is any difference shown in long-rank test. Last but not least, we use Generalized linear model to create a regression model of the a patient’s average expense (including number of regular visits and cost, emergency visits and cost, and days of hospitalization and cost) within the 2 years after his/her first visit. Also following Poisson distribution and Negative binomial distribution, and using Cox regression to form the regression model of the dialysis death rate. RESULT After adjusting the Disturbance factors of gender, age, elixhauser comorbidity index, duration of dialysis treatment, the result shows that the number of days of hospitalization of the group of patients who switch from Peritoneal Dialysis to Hemodialysis is 1.42 times more than the group of patients who received just hemodialysis treatment. (42% higher than the group of patients who received hemodialysis therapy in terms of number of days of hospitalization.) It shows a significant statistical difference. (p < 0.001) The total costs of hospitalization of P.D. switched to HD patients is 1.49 times higher than those of HD patients (49% higher than the costs of HD patients), which also shows a significant statistical difference. (p = 0.004). Average monthly cost of hospitalization of patients who switch from PD to HD in two years is higher than those who received just HD. In Cox analysis of mortality rate, the rate of death risk of patients who switch from PD to HD is 1.38 times higher than that of patients who received just HD treatment, which also reach a significant statistical difference. (p = 0.046). The study indicates that the rate of death risk of P.D. switched to HD is 1.38 times higher than HD. CONCLUSION This study shows that both the related costs and mortality rate of the patients who switch from P.D. to HD is higher compared to those who just received HD treatments. Hopefully this study can be a reference for policy makers when making related practices. The sampling of the study is obtained from two-year time frame of patients after they received the dialysis therapy. The number of patients who remain in the sampling decreases relatively due to the time factor. We expect to do a further analysis when extending the time frame.