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

Jeonghwan Lee, Jung Pyo Lee, Ji In Park, Jin Ho Hwang, Hye Min Jang, Ji Young Choi, Yong Lim Kim, Chul Woo Yang, Shin-Wook Kang, Nam Ho Kim, Yon Su Kim, Chun Soo Lim

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish
Article numbere99460
JournalPloS one
Volume9
Issue number6
DOIs
Publication statusPublished - 2014 Jun 13

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economic costs
Renal Replacement Therapy
Nephrology
Korea
cohort studies
Korean Peninsula
Dialysis
Cohort Studies
Referral and Consultation
Economics
kidneys
Prospective Studies
dialysis
Costs and Cost Analysis
therapeutics
health care costs
Costs
Health care
kidney diseases
Health Care Costs

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Lee, Jeonghwan ; Lee, Jung Pyo ; Park, Ji In ; Ho Hwang, Jin ; Jang, Hye Min ; Choi, Ji Young ; Kim, Yong Lim ; Yang, Chul Woo ; Kang, Shin-Wook ; Kim, Nam Ho ; Kim, Yon Su ; Lim, Chun Soo. / Early nephrology referral reduces the economic costs among patients who start renal replacement therapy : A prospective cohort study in Korea. In: PloS one. 2014 ; Vol. 9, No. 6.
@article{ad44355d9abc4be8ae3192ce1c1757f7,
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.",
author = "Jeonghwan Lee and Lee, {Jung Pyo} and Park, {Ji In} and {Ho Hwang}, Jin and Jang, {Hye Min} and Choi, {Ji Young} and Kim, {Yong Lim} and Yang, {Chul Woo} and Shin-Wook Kang and Kim, {Nam Ho} and Kim, {Yon Su} and Lim, {Chun Soo}",
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Lee, J, Lee, JP, Park, JI, Ho Hwang, J, Jang, HM, Choi, JY, Kim, YL, Yang, CW, Kang, S-W, Kim, NH, Kim, YS & Lim, CS 2014, 'Early nephrology referral reduces the economic costs among patients who start renal replacement therapy: A prospective cohort study in Korea', PloS one, vol. 9, no. 6, e99460. https://doi.org/10.1371/journal.pone.0099460

Early nephrology referral reduces the economic costs among patients who start renal replacement therapy : A prospective cohort study in Korea. / Lee, Jeonghwan; Lee, Jung Pyo; Park, Ji In; Ho Hwang, Jin; Jang, Hye Min; Choi, Ji Young; Kim, Yong Lim; Yang, Chul Woo; Kang, Shin-Wook; Kim, Nam Ho; Kim, Yon Su; Lim, Chun Soo.

In: PloS one, Vol. 9, No. 6, e99460, 13.06.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early nephrology referral reduces the economic costs among patients who start renal replacement therapy

T2 - A prospective cohort study in Korea

AU - Lee, Jeonghwan

AU - Lee, Jung Pyo

AU - Park, Ji In

AU - Ho Hwang, Jin

AU - Jang, Hye Min

AU - Choi, Ji Young

AU - Kim, Yong Lim

AU - Yang, Chul Woo

AU - Kang, Shin-Wook

AU - Kim, Nam Ho

AU - Kim, Yon Su

AU - Lim, Chun Soo

PY - 2014/6/13

Y1 - 2014/6/13

N2 - 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.

AB - 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.

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