title: Early nephrology referral reduces the economic costs among patients who start renal replacement therapy: a prospective cohort study in Korea.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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<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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea; Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji In
authors.initials: JI
authors.lastname: Park
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Statistics, Kyungpook National University, Daegu, Korea.
authors.forename: Hye Min
authors.initials: HM
authors.lastname: Jang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
mesh_terms: D000368:Aged; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000191:economics; D056910:Republic of Korea; D061665:Time-to-Treatment