The impact of diabetes on economic costs in dialysis patients: experiencesin Taiwan

Diabetes mellitus carries a great burden on healthcare costs due to its gro wing population and high co-morbidity. This adverse effect sustains even wh en patients develop end-stage renal disease (ESRD). We here present data sh owing the effect of diabetes on economic costs in dialysis therapy in Taiwa n. As of the end of 1997, we have 22 027 ESRD patients with a prevalence an d incidence rate of 1013 and 253 per million populations, respectively. Dia betic nephropathy is the second most common cause of the underlying renal d iseases, but accounts for 24.8% of the prevalent patients and 35.9% of the incident cases. The diabetic patients engendered 11.8% more expense for car e of dialysis than the non-diabetic patients (US$26988 vs. US$24 146 per pa tient-year). Higher inpatient cost mainly account for the difference. As co mpared to non-diabetic patients, the diabetic patients had 3.5 times more i npatients costs (US$1325 vs. US$4677 per patient-year), and higher proporti on of inpatient-to-annualized cost ratio (5.5 vs. 17.3%) resulting from the ir more frequent hospitalization (0.59 vs. 1.13 times per patient-year) and longer hospital stay (6.7 vs. 18.9 days per patient-year). The major cause s responsible for a more frequent hospitalization were cardiovascular disea se, poorly controlled hyperglycemia, sepsis and failure of vascular access. The annualized costs for care of dialysis patients in Taiwan, including in patient and outpatient costs, averaged US$25 576 per patient-year. This val ue is approximately half of that in most of the western countries and Japan . Thus, a more cost-effective way to achieve savings is to reduce the high incidence rate of dialysis population and to maximize the quality of dialys is treatment for avoiding hospitalization. Recent studies had shown that ti ght blood pressure control, intensive glycemic control, and use of angioten sin converting enzyme inhibitors in diabetic patients significantly reduced not only the rate of progressive renal failure, but also substantially red uced the cost of complications and led to higher cost effectiveness. Once d iabetic patients reach stage of ESRD, an optimized pre-ESRD care and consid eration of kidney transplantation are essential in terms of better patient survival and cost savings. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.