Trends of cost and mortality of patients on haemodialysis with end stage renal disease

Aim The prevalence of end-stage renal disease in Taiwan is among the highest in the world. Treatment reimbursement for haemodialysis was capped in 1996 in order to contain costs. This study evaluated temporal changes in the costs and utilization of medical care and mortality in patients receiving haemodialysis following capped reimbursement. Methods Using insurance claims data in Taiwan between 1998 to 2009, we established eight annual subcohorts of patients with incident haemodialysis, increasing from 6099 in 1998 to 7745 in 2005. With a 4-year follow-up paradigm for each subcohort, we evaluated resources use and costs of medical services, as well as mortality trends. Results The annual mean cost for each haemodialysis patient increased from US $431 to $737 for emergency visits, US $9007 to $13280 for hospitalizations and US $79141 to $92416 (16.8% increase) for total costs, from the initial to final subcohorts, respectively. Compared to the 1998 subcohort, the adjusted hazard ratio of deaths declined from 0.97 (95% CI 0.91 to 1.02) for the 1999 subcohort to 0.86 (95% CI 0.82 to 0.91) for the 2005 subcohort (P for trend <0.001). The corresponding cumulative probability of deaths decreased from 45.5% to 35.4%. Conclusions The mortality for patients with haemodialysis decreased annually, whereas the overall annual cost increased despite capped reimbursement for haemodialysis. These results encourage further study on reasons of increased uses of emergency service and hospitalization. Summary at a Glance This paper from Taiwan explores associations between fixed capitation payment introduced in a resource constrained health service and actual costs for health services. It shows improving trends in mortality across dialysis cohorts but a trend to increasing use of emergency services and other costs that may offset the fixed payment. Further studies are required to assess what factors contribute to these changes in costs and survival.