Medical costs, hospitalization and patient mortality among chronic kidney disease patients receiving multidisciplinary care

Purpose: To compare medical costs, hospitalization and patient mortality among chronic kidney disease (CKD) patients receiving multidisciplinary care (MDC) or usual care. Materials and methods: This retrospective observational study enrolled 822 subjects who initiated maintenance dialysis during 2006 to 2009.from five hospitals in Taiwan. Subjects were divided into MDC group (n=391), who were taken cared by nephrologists and CKD team more than 90 days pre-dialysis; usual care group (n=431) were referred or taken care by CKD team less than 90 days pre-dialysis. Medical costs (included in-hospital services, outpatient visits and emergency services) and primary clinical outcome (hospitalization risk and patients mortality) were calculated. Result: Average follow-up time was 33.6 months. The mean age was 62.8 years old (male, 51.5%). MDC group had higher prevalence in PD modality choice, lower temporary vascular catheter chance, and lower hospitalization rate at dialysis. Charlson Comorbidity Index (CCI) score of MDC group was lower than usual care group. Medical costs was no difference between the two groups in one year predialysis and 6 month after dialysis period. At dialysis initiation, usual care group had higher medical costs significantly. Estimated from 3 months predialysis until dialysis, MDC group could reduce US$ 1,975 dollars medical costs. MDC group was nearly associated with a 15% reduction in the risk of hospitalization. Conclusion: MDC patients had higher possibility of early-prepared dialysis access and higher prevalence in PD modality choice. MDC can reduce the risk of hospitalization and reduce hospital days and save medical costs at dialysis initiation.