Economic Burden Of Peritoneal Dialysis Patients With Renal Anemia And Medical Insurance Management Study

[Objective] This study aims to estimate the economic burden of peritoneal dialysis patients with renal anemia in China from social perspective and to advice the policy enhancement of medical insurance management.[Methods]8medical centers with regular follow-up system for peritoneal dialysis patients were selected for prospective observation research. During3-months follow-up duration, direct medical costs, direct non-medical costs and indirect costs were collected. Policy comparison and SWOT anaylsis were conducted based on the research.[Results]112patients with records of485outpatient visits and15inpatient stays were followed up. The mean age of patients is51.72with averagely3.87years of peritoneal dialysis treatment and3.69years of EPO treatment. The average number of visits per month was1.24visits in medical centers and1.01visits in community health centers. The average cost of EPO was CNY1379per month with average dosage of13645IU. Total economic burden per month per peritoneal dialysis patient was CNY9756, including CNY9162for direct medical costs, CNY210for direct non-medical costs and CNY383for indirect costs. Increasing1500IU EPO injection will raise CNY225cost per month. Reimbursement of peritoneal dialysis treatment is covered by different2reimbursement schemes:comsumables are bundled in medical service charge and dialysate is treated as drugs. Cost of peritoneal dialysis is lower than hemodialysis. Yet peritoneal dialysis percentage only accounts1/10in China. Hospital prefers hemodialysis due to the advantageous reimbursement policy. MOH took measures on research for several years and issued the new regulation in order to promote peritoneal dialysis in2011. NDRC newly published fee schedule of medical services for peritoneal dialysis treatment at home. Provincial Price bureau will set reasonable price for it and implement after Jan2014. United efforts among the government departments indicate that reimbursement policy of peritoneal dialysis treatment will become more accessible to the patients.[Conclusions] The economic burden of peritoneal dialysis patients with renal anemia was relatively high, which needs more attention from the government and the society. Peritoneal dialysis treatment will save the medical insurance expenditure and personal expenditure compared with hemodialysis treatment. Direct non-medical cost at outpatient for peritoneal dialysis has the room to decrease.[Suggestion]It is suggested to promote peritoneal dialysis treatment and explore new reimbursement payment method to encourage hospital to adopt peritoneal dialysis. Introduing the usage of long lasting EPO will reduce the indirect cost. Outpatient diagnostic items of peritoneal dialysis treatment follow up should be implemented strictly according to the guideline. It is important to design and develop large scale multiple center prospective observation research in the aspect of peritoneal dialysis treatment at home on health economic and clinical efficacy.