Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan: a combined survey and retrospective cohort analysis.
Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective.



A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L.



The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients.



The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients.



APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Chao-Hsiun
CH
Tang
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.|Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
Yu-Ting
YT
Wu
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Siao-Yuan
SY
Huang
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Hsi-Hsien
HH
Chen
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital and Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan.
Ming-Ju
MJ
Wu
Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan.
Bang-Gee
BG
Hsu
Department of Internal Medicine, Faculty of Renal Care, Kaohsiung Medical University Hospital and, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Jer-Chia
JC
Tsai
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Tso-Hsiao
TH
Chen
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Yuh-Mou
YM
Sue
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics* / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D013222:State Medicine; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
economic cost; medical utilization; peritoneal dialysis