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AimThis study aimed to examine associations between cognitive impairment and quality of life and healthcare utilization in patients with chronic kidney disease (CKD) stages 3 to 5.MethodsA cross‐sectional study was conducted in 379 outpatients with a mean age of 65.7 years at tertiary care hospitals in Thailand. Cognitive function was measured using the Mini‐Mental State Examination, and quality of life was measured using the five‐dimension European quality of life (EQ‐5D‐5L) multi‐attribute utility instrument. The effects of cognitive impairment on the likelihood of reporting ‘no problems’ for each EQ‐5D dimension, the quality of life scores and healthcare utilization were determined using an appropriate multivariate analysis.ResultsThe prevalence of cognitive impairment in patients with CKD stages 3 to 5 was 15.8% (95% confidence interval [CI], 12.3, 19.9). Patients with cognitive impairment had a significantly lower likelihood of achieving good outcomes in the mobility, self‐care, usual activities and anxiety/depression dimensions of the EQ‐5D‐5L than those with normal cognition. Patients with cognitive impairment had a significantly lower quality of life score than those with normal cognition by 0.06 points (95% CI, 0.01, 0.10). Cognitive impairment increased the number of emergency visits (rate ratio, RR, 3.47; 95% CI, 1.45, 8.29). Compared to CKD stage 3, CKD stage 5 decreased the quality of life score by 0.06 points (95% CI, 0.01, 0.10) and increased the rate of hospitalization (RR, 2.29; 95% CI, 1.27, 4.12).ConclusionCognitive impairment in patients with CKD was associated with lower quality of life scores and increased healthcare utilization.

Under the Universal Coverage Scheme (UCS) with payment per capita for outpatient (OP) services, hospitals’ financial risks will rise if access to essential drugs increases. This study examined trends in access to and price of essential drugs for noncommunicable diseases (NCDs) and an overall purchasing price index (PPI) for an OP drug basket from public hospitals. To examine drug access, OP prescription data from 2010–2012 were obtained from the UCS. Access to thirteen drugs for diabetes, hypertension, and dyslipidemia was examined for trend using a time-series analysis. To calculate the PPI, drugs in the same dataset in 2010 that each contributed at least 0.2% of the total OP drug expenditure (N = 118 items) were selected together with drugs expected for near future growth (N = 48 items). The PPI was constructed from purchasing prices in 16 hospitals using a standard method developed by the International Labour Organization. Based on 166 drug items accounting for 75% of OP drug expenditures, the overall PPI continually declined by 6.8% from 2010 to 2012. Access to the 13 selected NCD drugs, accounting for 22% of the total OP drug expenditure increased from 22 to 30 per 1,000 population for antidiabetics, 27 to 47 for antihypertensive agents, and 32 to 53 for antilipidemics from 2010–2012. Growth in the study drug recipients was relatively higher than that in the population and diagnosed patients. Due to generic market competition, metformin, glipizide, amlodipine, losartan, simvastatin, atorvastatin, and fenofibrate prices decreased by 6–22%. Antiretrovirals and risperidone prices decreased by more than 10% due to price negotiation by the UCS. Access to essential drugs for diabetes, hypertension and dyslipidemia has increased. A decline in the PPI could contain essential drug expenditure when the demand for the drugs increased. Generic market competition and price negotiation by the UCS led to price reduction.