全民健保腹膜透析比血液透析省錢嗎？

Is Peritoneal Dialysis Cheaper than Hemodialysis under National Health Insurance?

常逸平(Yi-Ping Chang) ； 錢慶文(Ching-Wen Chien) ； 楊耿如(Keng-Ju Yang)

《台灣公共衛生雜誌》 26卷5期 (2007/10) Pp. 400-408

https://doi.org/10.6288/TJPH2007-26-05-05

摘要

Objectives: To compare utilization of National Health Insurance (NHI) resources in terms of health expenses, including dialysis- and non-dialysis-related expenses, between hemodialysis (HD) and peritoneal dialysis (PD) patients. This study also analyzed the influence of different variables, such as gender, age, and disease severity, to two modalities of dialysis. Methods: This study was a retrospective study of new dialyzed patients and their health expenses between 2003 and 2005. Data were abstracted and analyzed from the inpatient/outpatient claim databases of the NHI for 30 consecutive months. Results: Two thousand four hundred seven patients were included in this study; 1,069 (44.4%) were males and 1,338 (55.6%) were females. Two thousand one hundred eighty-nine patients (90.94%) were classified as the ”HD” group and two hundred eighteen patients (9.06%) were classified as the ”PD” group. Most patients belonged to the 45-64 age group (46.28% of the total sample). The average Charlson Index was 5.06. The average individual outpatient dialysis expense in the PD group was NT$459,843/year and NT$618,306/year for the HD group. The average individual outpatient non-dialysis expense in the PD group was NT$47,388/year and NT$45,761/year for the HD group. The average individual inpatient dialysis expense in the PD group was NT$9,504/year and NT$18,981/year for the HD group. The average individual inpatient non-dialysis expense in the PD group was NT$ 37,531/year and NT$40,712/year for the HD group. Conclusions: The individual outpatient and inpatient dialysisrelated expenses of the PD group were significantly less expensive than the HD group (p＜0.001). However, PD patients were younger and had milder disease severity than the HD patients. There were no significant differences in outpatient and inpatient No-ndialysis-related expenses between the PD and HD groups.

關鍵字

血液透析 ； 腹膜透析 ； 透析費用 ； 察爾森合併症嚴重度指標

並列摘要

Objectives: To compare utilization of National Health Insurance (NHI) resources in terms of health expenses, including dialysis- and non-dialysis-related expenses, between hemodialysis (HD) and peritoneal dialysis (PD) patients. This study also analyzed the influence of different variables, such as gender, age, and disease severity, to two modalities of dialysis. Methods: This study was a retrospective study of new dialyzed patients and their health expenses between 2003 and 2005. Data were abstracted and analyzed from the inpatient/outpatient claim databases of the NHI for 30 consecutive months. Results: Two thousand four hundred seven patients were included in this study; 1,069 (44.4%) were males and 1,338 (55.6%) were females. Two thousand one hundred eighty-nine patients (90.94%) were classified as the ”HD” group and two hundred eighteen patients (9.06%) were classified as the ”PD” group. Most patients belonged to the 45-64 age group (46.28% of the total sample). The average Charlson Index was 5.06. The average individual outpatient dialysis expense in the PD group was NT$459,843/year and NT$618,306/year for the HD group. The average individual outpatient non-dialysis expense in the PD group was NT$47,388/year and NT$45,761/year for the HD group. The average individual inpatient dialysis expense in the PD group was NT$9,504/year and NT$18,981/year for the HD group. The average individual inpatient non-dialysis expense in the PD group was NT$ 37,531/year and NT$40,712/year for the HD group. Conclusions: The individual outpatient and inpatient dialysisrelated expenses of the PD group were significantly less expensive than the HD group (p＜0.001). However, PD patients were younger and had milder disease severity than the HD patients. There were no significant differences in outpatient and inpatient No-ndialysis-related expenses between the PD and HD groups.

並列關鍵字

Hemodialysis ； Peritoneal dialysis ； Dialysis cost ； Charlson Comobidity Index

參考文獻

Alloatti S,Manes M,Paternoster G,Gaiter AM,Molino A,Rosati C.(2000).Peritonal dialysis compared with hemodialysis in the treatment of end-stage renal disease.J Nephrol.13,331-342.

Bruns FJ,Seddon P,Saul M,Zeidel ML.(1998).The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.J Am Soc Nephrol.9,884-890.

Collins AJ,Kasiske B,Herzog C(2007).USRDS(The United States Renal Data System) 2006 ADR: international comparisons.Am J Kidney Dis.49,223-234.

Hooi LS,Lim TO,Goh A(2005).Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia.Nephrol.10,25-32.

Kalo Z,Jaray J,Nagy J.(2001).Economic evaluation of kidney transplantation versus hemodialysis in patients with end-stage renal disease in Hungary.Prog Transplant.11,188-193.