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Jirapanakorn S, Witthayapipopsakul W, Kusreesakul K, Lakhotia D, Tangcharoensathien V, Suphanchaimat R. All-cause excess mortality among end-stage renal disease (ESRD) patients during the COVID-19 pandemic in Thailand: a cross-sectional study from a national-level claims database. BMJ Open 2024; 14:e081383. [PMID: 38272543 PMCID: PMC10824030 DOI: 10.1136/bmjopen-2023-081383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES COVID-19 infection increased nephrology-related risks and mortality rate among end-stage renal disease (ESRD) patients. The pandemic also disrupted essential healthcare services. We aim to explore all-cause excess mortality among ESRD patients who were members of the Universal Coverage Scheme (UCS), the largest public health insurance scheme in Thailand covering citizens who are not employed in the formal sector, including children and older persons. DESIGN A cross-sectional study. SETTING We retrieved the dataset from the UCS claims database-electronic health records used for processing healthcare expense claims from medical facilities of all UCS members. This database links mortality outcome to civil registration. We employed the WHO's excess mortality methodology using pre-pandemic data to estimate expected deaths during the pandemic period (March 2020 to August 2022). PARTICIPANTS This study included ESRD patients from across Thailand, covered by the UCS. PRIMARY OUTCOME MEASURE Excess deaths are the difference between predicted and reported deaths. RESULTS Over a 30-month period of the pandemic, the total number of all-cause excess deaths among ESRD patients was 4966 (male 1284; female 3682). The excess death per 100 000 ESRD patients was 3601 (male 2012; female 4969). The relative excess death was 5.7% of expected deaths (95% CI 1.7%, 10.0%). The excess deaths were highly concentrated among patients aged 65 and older. CONCLUSION ESRD patients are significantly more vulnerable to pandemic-related mortality than the general population. Health systems' capacity to contain the pandemic at varying virulence and maintain essential health services for ESRD patients might be related to the size of excess deaths at different periods. The observed excess deaths highlight the importance of established strategies to reduce all-cause mortality such as rapid vaccine rollout for ESRD patients and sustaining dialysis and other essential services for older patients and other high-risk groups.
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Affiliation(s)
- Sutham Jirapanakorn
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Woranan Witthayapipopsakul
- International Health Policy Program, Nonthaburi, Thailand
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Divya Lakhotia
- International Health Policy Program, Nonthaburi, Thailand
| | | | - Rapeepong Suphanchaimat
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
- International Health Policy Program, Nonthaburi, Thailand
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Huynh TNP, Nguyen TM, Povero M, Pradelli L. Economic Analysis of a Ketoanalogue-supplemented Very Low-protein Diet in Patients With Chronic Kidney Disease in Vietnam. Clin Ther 2023; 45:649-654. [PMID: 37365045 DOI: 10.1016/j.clinthera.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The aim of this study was to estimate the cost-effectiveness of a very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids compared with a conventional low-protein diet (LPD) in Vietnam. METHODS The study was conducted from payer (base case), patient, and societal perspectives. A Markov model simulated costs and quality-adjusted life-years (QALYs) for patients with chronic kidney disease stage 4 or 5 (CKD4+) who were followed up during their lifetimes. Patients received a VLPD (0.3- to 0.4-g/kg/d diet) supplemented with ketoanalogues (5 kg/d [1 tablet]) versus LPD (0.6 g/kg/d, mixed proteins). In each model cycle, patient transitions among the health states-CKD4+ (nondialysis), dialysis, and death-were based on transition probabilities taken from the published literature. The time horizon covered the cohort's lifetime. Utilities and costs were estimated from literature review and projected for the lifespan considered in the model. Probabilistic and deterministic sensitivity analyses were performed. FINDINGS The ketoanalogue-supplemented VLPD increased survival and QALYs compared with the LPD. From a payer's perspective, total cost of care in Vietnam was ₫216,854,268 (€8684/$9242) per patient with LPD versus ₫200,928,819 (€8046/$8563) per patient with a supplemented VLPD (sVLPD) (difference, -₫15,925,449 [-€638/-$679]). From a patient's perspective, total cost of care in Vietnam was ₫217,872,043 (€8724/$9285) per patient with LPD versus ₫116,015,672 (€4646/$4944) per patient with sVLPD (difference, -₫101,856,371 [-€4,079/ -$4341]). From a societal perspective, total cost of care in Vietnam was ₫434,726,312 (€17,408/-$18,527) per patient with LPD versus ₫316,944,491 (€12,692/ $13,508) per patient with sVLPD (difference, -₫117,781,820 [-€4716 €/$5020). IMPLICATIONS Ketoanalogue-supplemented VLPD lowered costs compared with LPD in all 3 perspectives considered.
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Affiliation(s)
- Thao Ngoc Phuong Huynh
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho chi Minh City, Vietnam; Nephrology and Hemodialysis Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Tuan Minh Nguyen
- Department of Dialysis, Cho Ray Hospital, Hochiminh City, Vietnam
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Praditpornsilpa K, Garneata L, Lin YC, Povero M, Pradelli L, Susantitaphong P, Wu CH. Economic Analysis of a Ketoanalogue-Supplemented Very Low-Protein Diet in Patients With Chronic Kidney Disease in Taiwan and Thailand. J Ren Nutr 2023; 33:269-277. [PMID: 36179957 DOI: 10.1053/j.jrn.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE A vegetarian very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids Ketoanalogue-supplemented very low-protein diet (sVLPD) delays dialysis initiation in patients with chronic kidney disease (CKD). In this cost-effectiveness analysis, we compare an sVLPD with a conventional low-protein diet (LPD) in patients with CKD stage 4-5 using data from Taiwan and Thailand. DESIGN AND METHODS A Markov model simulated health outcomes and care costs in patients receiving an sVLPD (0.3-0.4 g/kg-day, vegetarian diet) supplemented with ketoanalogues (1 tablet/5 kg-day) or an LPD (0.6 g/kg-day, mixed proteins). Health state transition probability and resource cost inputs were based on published literature and local sources, respectively. RESULTS An sVLPD increased survival and quality-adjusted life years (QALYs) at a lower cost than an LPD. Total cost of care in Taiwan was 2,262,592.30 New Taiwan dollars (NTD) (68,059.35 EUR) with an LPD and 1,096,938.20 NTD (32,996.18 EUR) with an sVLPD (difference -1,165,654.10 NTD; -35,063.17 EUR). Total cost of care in Thailand was 500,731.09 Thai baht (THB) (14,584.12 EUR) with an LPD and 421,019.22 THB (12,262.46 EUR) with an sVLPD (difference -79,711.86 THB; -2,321.66 EUR). CONCLUSION A ketoanalogue-supplemented vegetarian sVLPD increased QALYs and lowered lifetime care costs versus an LPD in patients with predialysis CKD in Taiwan and Thailand. These data, together with the new KDOQI Guidelines for nutrition in CKD, support dietary intervention using ketoanalogue-supplemented vegetarian sVLPDs to prevent CKD progression and postpone dialysis as a cost-effective approach, with beneficial effects for patients and health care providers.
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Affiliation(s)
- Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Liliana Garneata
- "Carol Davila" University of Medicine and Pharmacy, Dept of Internal Medicine and Nephrology, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei Medical University Hospital, TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei, Taiwan
| | | | | | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Che-Hsiung Wu
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
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High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand. Sci Rep 2022; 12:18188. [PMID: 36307490 PMCID: PMC9616930 DOI: 10.1038/s41598-022-22538-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/17/2022] [Indexed: 12/31/2022] Open
Abstract
In Thailand, chronic kidney disease (CKD) screening was reported in 2009 with an overall prevalence of 17.5% and the highest at 22.2% in the northeastern region. This study aimed to find out CKD prevalence of the Kidney Disease Improving Global Outcomes criteria and their related risk factors in the rural community. A population-based study was conducted in the rural sub-districts of northeastern Thailand. Data of socio-demographic status, lifestyle, underlying diseases, blood pressure, and body mass index were recorded. Blood and urine analysis was conducted along with ultrasonography of kidneys. Specimen collection and analyses were repeated after 3 months, and the factors associated with CKD were studied by logistic regression analysis. A total of 2205 participants with a mean age of 57.8 ± 11.7 years and female predominance (66.7%) completed the study. The prevalence of CKD was 26.8%, i.e., stages 1 (7.3%); stage 2 (9.0%); stage 3a (6.0%); stage 3b (2.8%); stage 4 (1.4%); and stage 5 (0.3%). Hypertension, diabetes mellitus, and renal stones were the major underlying diseases. Only 3.5% of the participants were aware of having CKD. An increase in age, male, unemployment, current smoking, diabetes, hypertension, underweight, anemia, hyperuricemia, and leukocytosis were significantly associated factors with the disease. The study revealed that CKD has developed as a significant public health problem in rural northeastern Thailand and one out of every four people has CKD. Therefore, early interventions are essential for the proper management and prevention of CKD.
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Lukkanalikitkul E, Kongpetch S, Chotmongkol W, Morley MG, Anutrakulchai S, Srichan C, Thinkhamrop B, Chunghom T, Wiangnon P, Thinkhamrop W, Morley KE. Optimization of the Chronic Kidney Disease-Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study. JMIR Form Res 2022; 6:e37291. [PMID: 35793137 PMCID: PMC9301552 DOI: 10.2196/37291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 02/06/2023] Open
Abstract
Background The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding.
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Affiliation(s)
- Eakalak Lukkanalikitkul
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawinee Kongpetch
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wijittra Chotmongkol
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Michael G Morley
- Ophthalmic Consultants of Boston, Harvard Medical School, Boston, MA, United States
| | - Sirirat Anutrakulchai
- Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chavis Srichan
- Department of Computer Engineering, Faculty of Engineering, Khon Kaen University, Khon Kaen, Thailand
| | - Bandit Thinkhamrop
- Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Theenatchar Chunghom
- Kidney Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pongsai Wiangnon
- Kidney Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wilaiphorn Thinkhamrop
- Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Katharine E Morley
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, United States
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毕 书, 李 紫, 汪 涛, 王 悦, 张 晨, 计 虹, 石 菊. [Trend in medical expenditures for patients with kidney diseases: An analysis from a tertiary hospital in Beijing]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 53:215-219. [PMID: 33550360 PMCID: PMC7867976 DOI: 10.19723/j.issn.1671-167x.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate trends in hospitalization expenditures in adults with kidney disease, to analyze the time pattern of outpatient and inpatient medical expenditures for patients with kidney diseases, and to support the health care reform by exploring the causes. METHODS Medical expenditure data for kidney disease patients aged ≥18 years from the outpatient and in-patient data of the information center in the Grade?A tertiary hospital in Beijing, China from January 1, 2012, to December 31, 2017, were retrospectively analyzed. It provided descriptive evidence on the time patterns of expenditures per visit and capita, and potential influencing factors of the time changes were further explored. RESULTS It was found that medical expenditures had increased rapidly from 2012 to 2017. The result showed that the average outpatient expenditure per capita for kidney disease patients was 4 598 yuan in 2012, with an increasing tendency to 11 536 yuan in 2017. There was an obvious increase in the average number of visits (per year) from 3.94 in 2012 to 9.11 in 2017. Meanwhile, the mean inpatient expenditures per capita had an increasing tendency from 323 753 yuan in 2012 to 45 904 yuan in 2017. There was also an increase of mean inpatient expenditures per admission from 27 184 yuan in 2012 to 34 933 yuan in 2017, with a similar number of admissions over the 6 years. The increases in outpatient and inpatient expenditures per capita were driven by different reasons. The increase in outpatient expenditures per capita was driven by the increase of patient visits, while the increase in inpatient expenditures per capita was driven by the increase of the expenditures per admission. Also, drug and medical materials were the two categories that had the largest contribution to the inpatient expenditures. Drug expenses were the highest one, with an average of 12 524 yuan per visit in 2017, accounting for 32.4% of the average total expenditure in that year, while the average cost of consumables was 9 215 yuan, accounting for 23.9%. CONCLUSION The increase of outpatient expenditures per capita was related to the increase of patient visits. Meanwhile, the growth of drug and consumable costs contributed to the total increase in the total inpatient healthcare costs. It is necessary to increase the proportion of treatment costs and medical service fees in the total expenditure.
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Affiliation(s)
- 书红 毕
- 北京大学第三医院肾内科, 北京 100191Division of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 紫繁 李
- 北京大学经济学院, 北京 100871School of Economics, Peking University, Beijing 100871, China
| | - 涛 汪
- 北京大学第三医院肾内科, 北京 100191Division of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 悦 王
- 北京大学第三医院肾内科, 北京 100191Division of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 晨 张
- 北京大学第三医院信息管理与大数据中心, 北京 100191Data Center, Peking University Third Hospital, Beijing 100191, China
| | - 虹 计
- 北京大学第三医院信息管理与大数据中心, 北京 100191Data Center, Peking University Third Hospital, Beijing 100191, China
| | - 菊 石
- 北京大学经济学院, 北京 100871School of Economics, Peking University, Beijing 100871, China
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Yan LD, Hanvoravongchai P, Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Neelapaichit N, Stokes AC. Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. PLoS One 2020; 15:e0226286. [PMID: 31940366 PMCID: PMC6961827 DOI: 10.1371/journal.pone.0226286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. Methods We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. Findings We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. Conclusions Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.
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Affiliation(s)
- Lily D. Yan
- Internal Medicine, Boston Medical Center, Boston, MA, United States of America
| | | | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Nareemarn Neelapaichit
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Thailand Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew C. Stokes
- Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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Silva Junior GBD, Oliveira JGRD, Oliveira MRBD, Vieira LJEDS, Dias ER. Global costs attributed to chronic kidney disease: a systematic review. Rev Assoc Med Bras (1992) 2018; 64:1108-1116. [DOI: 10.1590/1806-9282.64.12.1108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
SUMMARY The aim of this study is to discuss the global costs attributed to chronic kidney disease (CKD) and its impact on healthcare systems of developing countries, such as Brazil. This is a systematic review based on data from PubMed/Medline, using the key words “costs” and “chronic kidney disease”, in January 2017. The search was also done in other databases, such as Scielo and Google Scholar, aiming to identify regional studies related to this subject, published in journal not indexed in PubMed. Only papers published from 2012 on were included. Studies on CKD costs and treatment modalities were prioritized. The search resulted in 392 articles, from which 291 were excluded because they were related to other aspects of CKD. From the 101 remaining articles, we have excluded the reviews, comments and study protocols. A total of 37 articles were included, all focusing on global costs related to CKD. Despite methods and analysis were diverse, the results of these studies were unanimous in alerting for the impact (financial and social) of CKD on health systems (public and private) and also on family and society. To massively invest in prevention and measures to slow CKD progression into its end-stages and, then, avoid the requirement for dialysis and transplant, can represent a huge, and not yet calculated, economy for patients and health systems all over the world.
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Chandoevwit W, Phatchana P. Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life. Soc Sci Med 2018; 207:64-70. [PMID: 29730551 DOI: 10.1016/j.socscimed.2018.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
Abstract
The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended.
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Affiliation(s)
- Worawan Chandoevwit
- Faculty of Economics, Khon Kaen University, 123 Mitraphab Rd., Muang, Khon Kaen, 40002, Thailand.
| | - Phasith Phatchana
- Thailand Development Research Institute, 565 Ramkhamhaeng Rd. Soi 39, Bangkok, 10310, Thailand.
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Ganu VJ, Boima V, Adjei DN, Yendork JS, Dey ID, Yorke E, Mate-Kole CC, Mate-Kole MO. Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study. Ghana Med J 2018; 52:22-28. [PMID: 30013257 PMCID: PMC6026941 DOI: 10.4314/gmj.v52i1.5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. DESIGN Study design was cross-sectional. SETTING Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. PARTICIPANTS AND STUDY TOOLS One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. RESULTS Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. CONCLUSION Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing. FUNDING Not indicayed.
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Affiliation(s)
- Vincent J Ganu
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra
| | - Vincent Boima
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - David N Adjei
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box 4236, Accra
| | | | - Ida D Dey
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - Ernest Yorke
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - Charles C Mate-Kole
- Department of Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Box 4236, Accra
- Department of Psychology, University of Ghana, Legon
- Centre for Ageing Studies, University of Ghana, Legon
| | - Michael O Mate-Kole
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
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Chan-On C, Sarwal MM. A Comprehensive Analysis of the Current Status and Unmet Needs in Kidney Transplantation in Southeast Asia. Front Med (Lausanne) 2017; 4:84. [PMID: 28691007 PMCID: PMC5481314 DOI: 10.3389/fmed.2017.00084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/06/2017] [Indexed: 01/24/2023] Open
Abstract
To address the unmet needs in the face of a growing demand for end-stage renal failure management and kidney transplantation in Asia, we have conducted a critical analysis of published literature and national registries to evaluate clinical outcomes and the rates of organ donation in Southeast Asia and the challenges facing these regions with regards to regulation, choice of donor source, and funding. Based on the available data, suggestions are proposed for an advancement of rates of organ donation and access, with emphasis on improved regulation and public education.
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Affiliation(s)
- Chitranon Chan-On
- Division of Nephrology, Faculty of Medicine, Department of Internal Medicine, Khon Kaen University, Khon Kaen, Thailand.,Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Minnie M Sarwal
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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Zaman SB. Detection of Chronic Kidney Disease by Using Different Equations of Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analysis. Cureus 2017; 9:e1352. [PMID: 28721320 PMCID: PMC5510968 DOI: 10.7759/cureus.1352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) is a global threat due to its high mortality. It is essential to know the actual magnitude of diabetic CKD to design a specific management program. However, there is limited knowledge regarding the most suitable equation to measure CKD in patients with Type 2 diabetes mellitus (T2DM). This paper aimed to analyze estimated glomerular filtration rate (eGFR) based on different equations to detect the CKD among T2DM. Methods A hospital-based cross-sectional study was carried out, and a clinical registry was used to collect 4,042 T2DM patients from a large district hospital in Northeast Thailand. CKD patients were diagnosed when eGFR was less than 60 ml/min/1.73m2. Using Stata statistical software (StataCorp LP, College Station, TX), three standard equations, such as ‘modification of diet in renal disease (MDRD-4)’, ‘chronic kidney disease epidemiology collaboration (CKD-EPI)’, and ‘Cockcroft-Gault (C-G)' equations, were used to produce eGFR values to report and compare stages of CKD. Results The mean age of the patients was 61.4 (± 10.7) years and male to female ratio was 1:1.9. According to the MDRD-4, CKD-EPI, and C-G equation, the prevalence of diabetic CKD was 21.4%, 21.9%, and 31.4%, respectively, and the frequency of CKD Stage 3 to 5 was found to be different among T2DM. About 3,789 (93.9%) measurements appeared to be classified as different stages of CKD (Stages 1 to 5) between MDRD-4 and CKD-EPI equations (kappa: 0.905; 95% confidence interval (CI): 0.83 - 0.97, p < 0.001). However, this study found that the above-mentioned agreement was 70.9% between CKD-EPI and C-G equation (kappa: 0.56, 95% CI: 0.44 - 0.67, p < 0.001). Conclusions CKD-EPI equations can overcome the constraint of MDRD-4 and C-G equations to report CKD and can be used in patients with T2DM.
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Affiliation(s)
- Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh
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Anutrakulchai S, Mairiang P, Pongskul C, Thepsuthammarat K, Chan-on C, Thinkhamrop B. Erratum to: Mortality and treatment costs of hospitalized chronic kidney disease patients between the three major health insurance schemes in Thailand. BMC Health Serv Res 2016; 16:614. [PMID: 27782835 PMCID: PMC5080797 DOI: 10.1186/s12913-016-1874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022] Open
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