Early nephrology referral reduces the economic costs among patients who start renal replacement therapy: a prospective cohort study in Korea

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. A total of 879 patients who were newly diagnosed as having end-stag...

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Published in:PloS one 2014-06, Vol.9 (6), p.e99460-e99460
Main Authors: Lee, Jeonghwan, Lee, Jung Pyo, Park, Ji In, Hwang, Jin Ho, Jang, Hye Min, Choi, Ji-Young, Kim, Yong-Lim, Yang, Chul Woo, Kang, Shin-Wook, Kim, Nam-Ho, Kim, Yon Su, Lim, Chun Soo
Format: Article
Language:English
Subjects:
Aged
Analysis
Chronic kidney failure
Cohort analysis
Comorbidity
Cost analysis
Cost control
Costs
Data acquisition
Dialysis
Economic aspects
Economic impact
End-stage renal disease
Female
Health care
Health Care Costs
Hospitals
Humans
Internal medicine
Kidney diseases
Kidney Failure, Chronic - economics
Kidney Failure, Chronic - therapy
Kidney transplantation
Male
Medical economics
Medical research
Medicare
Medicine
Medicine and Health Sciences
Middle Aged
Morbidity
Mortality
Multivariate analysis
Nephrology
Patients
Peritoneal dialysis
Population
Prospective Studies
Quality of life
Referral and Consultation
Renal Dialysis - economics
Republic of Korea
Therapy
Time-to-Treatment
Transplants & implants
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cited_by cdi_FETCH-LOGICAL-c692t-8d56cdfb3f975788564ea06272d7cf46cf48d038b3ef8b936a6d5711e570d2f63
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creator Lee, Jeonghwan
Lee, Jung Pyo
Park, Ji In
Hwang, Jin Ho
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Kang, Shin-Wook
Kim, Nam-Ho
Kim, Yon Su
Lim, Chun Soo
description 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. A 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. The 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
doi_str_mv 10.1371/journal.pone.0099460
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We evaluated the health care costs before and after dialysis according to the referral time. A 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. The 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&lt;0.001). In the multivariate analysis, ER significantly lowered the health care costs during the 12 months before (2534.0 ± 436.2 USD, P&lt;0.001) and the first month (428.5 ± 172.3 USD, P = 0.013) after the initiation of dialysis. 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Lee, Jung Pyo ; Park, Ji In ; Hwang, Jin Ho ; Jang, Hye Min ; Choi, Ji-Young ; Kim, Yong-Lim ; Yang, Chul Woo ; Kang, Shin-Wook ; Kim, Nam-Ho ; Kim, Yon Su ; Lim, Chun Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-8d56cdfb3f975788564ea06272d7cf46cf48d038b3ef8b936a6d5711e570d2f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Analysis</topic><topic>Chronic kidney failure</topic><topic>Cohort analysis</topic><topic>Comorbidity</topic><topic>Cost analysis</topic><topic>Cost control</topic><topic>Costs</topic><topic>Data acquisition</topic><topic>Dialysis</topic><topic>Economic aspects</topic><topic>Economic impact</topic><topic>End-stage renal disease</topic><topic>Female</topic><topic>Health care</topic><topic>Health Care Costs</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - economics</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Kidney transplantation</topic><topic>Male</topic><topic>Medical economics</topic><topic>Medical research</topic><topic>Medicare</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Nephrology</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Population</topic><topic>Prospective Studies</topic><topic>Quality of life</topic><topic>Referral and Consultation</topic><topic>Renal Dialysis - economics</topic><topic>Republic of Korea</topic><topic>Therapy</topic><topic>Time-to-Treatment</topic><topic>Transplants &amp; 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Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Meteorological &amp; Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agriculture Science Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Biological Science Journals</collection><collection>Engineering Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest advanced technologies &amp; aerospace journals</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials science collection</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Jeonghwan</au><au>Lee, Jung Pyo</au><au>Park, Ji In</au><au>Hwang, Jin Ho</au><au>Jang, Hye Min</au><au>Choi, Ji-Young</au><au>Kim, Yong-Lim</au><au>Yang, Chul Woo</au><au>Kang, Shin-Wook</au><au>Kim, Nam-Ho</au><au>Kim, Yon Su</au><au>Lim, Chun Soo</au><au>James, Leighton R.</au><aucorp>CRC for ESRD investigators</aucorp><aucorp>CRC for ESRD investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early nephrology referral reduces the economic costs among patients who start renal replacement therapy: a prospective cohort study in Korea</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-06-13</date><risdate>2014</risdate><volume>9</volume><issue>6</issue><spage>e99460</spage><epage>e99460</epage><pages>e99460-e99460</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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. A 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. The 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&lt;0.001). In the multivariate analysis, ER significantly lowered the health care costs during the 12 months before (2534.0 ± 436.2 USD, P&lt;0.001) and the first month (428.5 ± 172.3 USD, P = 0.013) after the initiation of dialysis. The 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24927081</pmid><doi>10.1371/journal.pone.0099460</doi><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
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issn 1932-6203
1932-6203
language eng
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subjects Aged
Analysis
Chronic kidney failure
Cohort analysis
Comorbidity
Cost analysis
Cost control
Costs
Data acquisition
Dialysis
Economic aspects
Economic impact
End-stage renal disease
Female
Health care
Health Care Costs
Hospitals
Humans
Internal medicine
Kidney diseases
Kidney Failure, Chronic - economics
Kidney Failure, Chronic - therapy
Kidney transplantation
Male
Medical economics
Medical research
Medicare
Medicine
Medicine and Health Sciences
Middle Aged
Morbidity
Mortality
Multivariate analysis
Nephrology
Patients
Peritoneal dialysis
Population
Prospective Studies
Quality of life
Referral and Consultation
Renal Dialysis - economics
Republic of Korea
Therapy
Time-to-Treatment
Transplants & implants
title Early nephrology referral reduces the economic costs among patients who start renal replacement therapy: a prospective cohort study in Korea
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