Does disease management for diabetic nephropathy reduce medical expenditure? Evidence from a three-period difference-in-differences analysis

Kawaguchi, Hiroyuki; Moriyama, Michiko; Hashimoto, Hideki

doi:10.1186/s12913-020-05297-0

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…Decreasing unnecessary hospitalizations can lower the cost of CKD [ 26 ]. A good follow-up of diabetic patients can prevent the progression of diabetic nephropathy [ 27 ], knowing that diabetes is causing 10% of the global health expenditure and kidney disease is one of the most expensive diabetic complications [ 28 ]. Our study has highlighted the impact of some factors such as age, diabetes, albuminuria and coronary artery disease on the total cost in CKD-ND patients.…”

Section: Discussionmentioning

confidence: 99%

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

Aoun

Helou

Sleilaty

et al. 2022

BMC Health Serv Res

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Background Chronic kidney disease (CKD) is the 12th leading cause of death worldwide. Cost-of-illness studies of CKD are scarce in developing countries. This study aims to estimate the cost of illness of all stages of CKD in Lebanon, from early stages until dialysis and kidney transplantation. The secondary objective is to identify factors related to the highest financial burden. Methods This is a cross-sectional study of CKD patients who presented to two nephrology clinics during November 2020. Their medical and administrative records were reviewed for collection of demographics, CKD characteristics, direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. Logistic regression analysis was used to evaluate risk factors associated with costs. Results The sample included 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 transplant patients. Their mean age was 66.74 ± 15.36 years, 57.5% were males and 42.5% diabetics. The total median cost per year of CKD across all categories was assessed to be 7,217,500 Lebanese Pounds (3,750,000–35,535,250; 1 $USD = 1515 LBP in 2019) from the societal perspective and 5,685,500 LBP (2,281,750- 32,386,500) from the third-party payer perspective. Statistical analysis showed a higher total cost in hemodialysis (p < 0.001), higher cost of medications in transplant (p < 0.001) and higher cost in technique modality in peritoneal dialysis (p < 0.001). In a sub-analysis of hemodialysis patients, dialysis vintage negatively correlated with total societal cost (r = -0.391, p = 0.013); the regression analysis found diabetes as a risk factor for higher cost (OR = 2.3; 95%CI: 0.638,8.538; p = 0.201). In the subcategory of CKD-ND patients, age correlated with total societal cost (r = 0.323, p = 0.001); diabetes and coronary artery disease were significantly associated with higher total cost (OR = 2.4; 95%CI: 1.083,5.396; p = 0.031; OR = 3.7; 95%CI: 1.535,8.938; p = 0.004). Conclusions This cost of illness study showed a high burden of hemodialysis and peritoneal dialysis cost compared to transplant and non-dialysis CKD patients. It revealed a significantly higher cost of medications in transplant patients. Health policies should target interventions that prevent end-stage kidney disease and encourage kidney transplantation.

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Section: Discussionmentioning

confidence: 99%

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

Aoun

Helou

Sleilaty

et al. 2022

BMC Health Serv Res

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“…Previous studies have recommended using propensity score weighting in the context of parametric Difference-in-Differences (DID) models to evaluate the causal effect of a policy or program [ 39 ]. Instead of dividing the study into two time periods—a practice employed in most DID analyses—following a previous study [ 40 ] we divided the study into three time periods: before the Pre-K period, during the Pre-K period, and after the Pre-K period. As we demonstrated Section 1.2 , one of the plausible pathways showing how Pre-K attendance affects children’s health outcomes can be separated into two processes: (a) detection of disease and (b) subsequent treatment for the disease.…”

Section: Methodsmentioning

confidence: 99%

A Quasi-Experimental Study of the Effects of Pre-Kindergarten Education on Pediatric Asthma

Masuda

Lanier

Peisner-Feinberg

et al. 2021

IJERPH

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Ensuring access to pre-kindergarten (Pre-K) education remains a pressing policy issue in the United States. Prior research has shown the positive effects that Pre-K has on children’s cognitive development. However, studies on its effects on children’s health outcomes are scarce. This study aimed to investigate the effects of the Pre-K program on pediatric asthma. Children’s individual data from existing research conducted in North Carolina were linked with state Medicaid claims data from 2011–2017. There were 51,408 observations (person-month unit) of 279 children enrolled in Pre-K and 333 unenrolled children. Asthma was identified using the ICD 9/10 codes. A difference-in-differences model was adopted using a panel analysis with three time periods: before, during, and after Pre-K. The explanatory variables were interaction terms between Pre-K enrollment and (a) before vs. during period and (b) during vs. after period. The results indicated that children enrolled in Pre-K had a greater risk of asthma diagnosis during Pre-K (b = 0.0145, p = 0.058). Conversely, in the post-intervention period, the enrolled children had a lower of receiving an asthma diagnosis (b = −0.0216, p = 0.002). These findings indicate that Pre-K may increase the use of asthma-related health services in the short term and decrease the service use after participants leave the program.

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“…In previous studies, we took advantage of the universal public health insurance scheme in Japan to overcome attrition and data quality limitations through the use of electronic administrative records [ 13 – 15 ]. In preliminary analyses, we found improvement of hemoglobin A1c, maintenance of renal function, and modification of patient behavior during a mean 1-year follow-up [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…In preliminary analyses, we found improvement of hemoglobin A1c, maintenance of renal function, and modification of patient behavior during a mean 1-year follow-up [ 13 , 14 ]. We also found reduced cost during a mean 2-year follow-up that was attributable to amended treatment processes and improved prognosis of the disease [ 15 ]. However, the majority of the previous studies including ours had a short-term design, with an evaluation period of less than 3 years.…”

Section: Introductionmentioning

confidence: 99%

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan

et al. 2022

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Background Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. Methods Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. Results The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. Conclusions The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

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Does disease management for diabetic nephropathy reduce medical expenditure? Evidence from a three-period difference-in-differences analysis

Cited by 6 publications

References 21 publications

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

A Quasi-Experimental Study of the Effects of Pre-Kindergarten Education on Pediatric Asthma

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan

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