title: Trends of cost and mortality of patients on haemodialysis with end stage renal disease.
abstract: OBJECTIVE
  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 $13,280 for hospitalizations and US $79,141 to $92,416 (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.
authors.affiliation: Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Chunan, Taiwan.
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Chang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chen
authors.forename: Yi-Shan
authors.initials: YS
authors.lastname: Chen
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000368:Aged; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D005102:Health Expenditures / Q000639:trends; D017721:Hospital Costs / Q000639:trends; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000639:trends; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: cohort study; cost; dialysis; end stage renal disease; mortality; resources use; time trends