Treatment Costs for Patients with Chronic Kidney Disease Who Received Multidisciplinary Care in a District Hospital in Thailand

Figures & data

Table 1 Patients’ Characteristics

Characteristics	CKD G3a (n=123)	CKD G3b (n=67)	CKD G4 (n=22)	All (n=212)	P-value
Male sex (n)	50 (40.70)	17 (25.40)	8 (36.40)	75 (35.40)	0.110
Age (years)	68.11 ± 10.05	72.00 ± 9.70	68.82 ± 10.52	69.42 ± 10.10	0.038*
<65	44 (35.80)	15 (22.40)	8 (36.40)	67 (31.60)
≥65	79 (64.20)	52 (77.60)	14 (63.60)	145 (68.40)
Hypertension (n)	117 (95.10)	64 (95.50)	18 (81.80)	199 (93.90)	0.045*
Diabetes mellitus (n)	37 (30.10)	23 (34.30)	14 (63.60)	74 (34.90)	0.009*
Dyslipidemia (n)	61 (49.60)	31 (46.30)	13 (59.10)	105 (49.50)	0.584
MI/CHF (n)	1 (0.80)	3 (4.50)	2 (9.10)	6 (2.80)	0.060
Length of stay (day)	1.19 ± 0.45	1.19 ± 0.44	1.50 ± 0.67	1.29 ± 0.68	0.001*
0	103 (83.74)	55 (82.09)	13 (59.08)	171 (80.70)
1–7	17 (13.82)	11 (16.42)	7 (31.82)	35 (16.50)
≥8	3 (2.44)	1 (1.49)	2 (9.10)	6 (2.80)
Ambulatory visit (visit)	6.55 ± 2.74	6.22 ± 2.21	6.32 ± 1.96	6.42 ± 2.50	0.674
1–4	15 (12.20)	11 (16.40)	3 (13.60)	29 (13.70)
5–7	82 (66.70)	44 (65.70)	13 (59.10)	139 (65.60)
≥8	26 (21.10)	12 (17.90)	6 (27.30)	44 (20.80)
BMI (kg/m^2)	23.94 ± 3.85	23.77 ± 4.92	23.93 ± 3.55	23.89 ± 4.17	0.962
SBP (mmHg)	140.38 ± 14.42	140.54 ± 13.67	141.59 ± 15.51	140.55 ± 14.24	0.935
FBG (mg/dL)	103.41 ± 28.63	109.10 ± 41.98	121.11 ± 25.60	107.04 ± 33.47	0.060
HbA1c (%), n=74	6.46 ± 0.84	7.10 ± 1.70	6.80 ± 1.30	6.72 ± 1.26	0.151
<7%	29 (78.40)	13 (56.50)	7 (50.00)	49 (66.20)
≥7%	8 (21.60)	10 (43.50)	7 (50.00)	25 (33.80)
TG (mg/dL)	159.82 ± 83.65	165.69 ± 119.90	180.34 ± 79.79	163.81 ± 96.00	0.643
LDL (mg/dL)	114.80 ± 31.31	110.48 ± 39.13	120.89 ± 39.76	114.07 ± 34.82	0.449
HDL (mg/dL)	45.82 ± 11.76	43.80 ± 8.68	42.18 ± 10.58	44.80 ± 10.78	0.227
BUN (mg/dL)	16.65 ± 4.97	22.28 ± 12.54	29.12 ± 7.77	19.72 ± 9.29	<0.001*
Scr (mg/dL)	1.20 ± 0.17	1.45 ± 0.21	2.29 ± 0.56	1.39 ± 0.41	<0.001*
eGFR (mL/min/1.73m^2)	53.11 ± 3.41	39.43 ± 4.02	25.08 ± 6.33	45.88 ± 10.23	<0.001*

Note: *P-value <0.05.

Abbreviations: BMI, body mass index; BUN, blood urea nitrogen; CHF, chronic heart failure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; FBG, fasting blood glucose; HbA1c, hemoglobin A1c; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; MI, myocardial infarction; SBP, systolic blood pressure; Scr, serum creatinine; TG, triglyceride; CKD G3a, chronic kidney disease stage G 3a (GFR 45–59 mL/min/1.73 m²); CKD stage 3b, chronic kidney disease stage G 3b (GFR 30–44 mL/min/1.73 m²); CKD G4, chronic kidney disease stage G 4 (GFR 15–29 mL/min/1.73 m²).

Table 2 Treatment Cost by Chronic Kidney Disease Stages (per Year)

Cost	CKD Stage G3a (n=123)			CKD Stage G3b (n=67)			CKD Stage G4 (n=22)			All (n=212)
	Mean ± SD	Diff	P-value	Mean ± SD	Diff	P-value	Mean ± SD	Diff	P-value	Mean ± SD	Diff	P-value
Ambulatory Cost
Year 1 THB	3843.01 ± 1697.63	12.42	0.929	4407.83 ± 3238.75	156.58	0.235	6353.90 ± 3551.12	−98.89	0.851	4282.08 ± 2601.43	46.43	0.658
(USD)	(117.13 ± 51.74)	(0.38)		(134.34 ± 98.71)	(4.78)		(193.66 ± 108.23)	(−3.02)		(130.51 ± 79.29)	(1.41)
Year 2 THB	3855.43 ± 1642.64			4564.41 ± 2926.20			6255.00 ± 2901.36			4328.51 ± 2368.84
(USD)	(117.51 ± 50.06)			(139.12 ± 89.18)			(190.64 ± 88.43)			(131.92 ± 8.19)
Hospitalization Costs (All Cases)
Year 1 THB	1070.58 ± 3353.69	−260.30	0.411	1066.23± 2974.42	1144.28	0.106	4443.83 ± 6956.42	−2516.42	0.126	1419.26 ± 3892.43	−50.52	0.880
(USD)	(32.63 ± 102.21)	(−7.93)		(32.50 ± 90.66)	(34.87)		(135.44 ± 212.02)	(76.7)		(43.26 ± 118.63)	(−1.54)
Year 2 THB	810.28 ± 2169.13			2210.51 ± 6503.92			1927.41 ± 3242.37			1368.74 ± 4175.85
(USD)	(24.70 ± 66.11)			(67.37 ± 198.23)			(58.74 ± 98.82)			(41.72 ± 127.27)
Hospitalization Cost (only Admitted Patients)
Year 1 THB	(n=20) 6584.08 ± 5831.56	−1838.15	0.209	(n=12) 5953.11 ± 4620.21	6388.92	0.074	(n=9) 10,862.70 ± 6970.38	−4805.13	0.109	(n=41) 7338.62 ± 5949.43	−84.32	0.954
(USD)	(200.67 ± 177.74)	(−56.02)		(181.44 ± 140.82)	(144.28)		(331.08 ± 212.44)	(−146.46)		(223.67 ± 181.33)	(−2.57)
Year 2 THB	(n=21) 4745.93 ± 3014.80			(n=12) 12,342.03 ± 10,834.89			(n=7) 6057.57 ± 2758.04			(n=40) 7254.30 ± 7110.02
(USD)	(144.65 ± 91.88)			(376.16 ± 330.23)			(184.62 ± 84.06)			(221.10 ± 216.70)
Total Cost
Year 1 THB	4913.59 ± 4266.90	−247.88	0.529	5474.06 ± 5230.63	1300.86	0.068	10,797.73 ± 8950.33	−2615.31	0.187	5701.34 ± 5490.35	−4.10	0.991
(USD)	(149.76 ± 130.05)	(−7.56)		(166.84 ± 159.42)	(39.65)		(329.10 ± 272.79)	(−79.72)		(173.77 ± 167.34)	(−0.13)
Year 2 THB	4665.71 ± 3027.52			6774.92 ± 7976.68			8182.41 ± 5235.81			5697.24 ± 5437.23
(USD)	(142.20 ± 92.27)			(206.49 ± 243.12)			(249.38 ± 159.58)			(173.64 ± 165.72)

Notes: 1 THB = 0.03048 USD (exchange rate from Bank of Thailand on March 30, 2020). Diff, difference which calculated by cost in year 1 minus cost in year 2; P, p-value; CKD stage 3a, GFR 45–59 mL/min/1.73 m²; CKD stage 3b, GFR 30–44 mL/min/1.73 m²; CKD stage 4, GFR 15–29 mL/min/1.73 m².

Abbreviations: SD, standard deviation; CKD, chronic kidney disease.

Table 3 Treatment Costs by Patients’ Characteristics (THB per Year)

Characteristics	Ambulatory Cost (n=212)			Hospitalization Cost (n=41)			Total Cost (n=212)
	Mean ± SD	Difference	P-value	Mean ± SD	Difference	P-value	Mean ± SD	Difference	P-value
Age (years)
<65	4902.94 ± 3405.33	−907.75	0.018*	9545.47 ± 8838.39	−2918.74	0.181	6327.64 ± 7220.89	−915.70	0.260
≥65	3995.19 ± 2083.03			6626.73 ± 4648.88			5411.94 ± 4472.62
Length of Stay (days)
0	4002.04 ± 1940.27	Reference	–	–	–	–	4002.04 ± 1940.27	Reference	–
1–7	4547.37 ± 4586.44	545.32	0.428	3903.96 ± 1550.77	2465.14	0.182	9979.88 ± 5068.61	5977.84	<0.001*
≥8	10,715.47 ± 7697.89	6713.43	<0.001*	6369.09 ± 5265.09			29,173.01 ± 9021.07	25,170.97	<0.001*
Ambulatory Visit
1–4	2527.25 ± 1483.11	Reference	–	3903.95 ± 3101.54	Reference	–	3065.73 ± 2233.43	Reference	–
5–7	4176.08 ± 2013.18	1648.83	0.003*	6369.09 ± 5265.09	2465.14	0.447	5046.68 ± 3807.18	1980.95	0.142
≥8	5773.50 ± 3792.00	3246.25	<0.001*	9125.26 ± 6710.31	5221.31	0.114	9506.57 ± 8789.96	6440.84	<0.001*
CKD Stage
G3a	3843.01 ± 1697.63	Reference	–	6584.08 ± 5831.56	Reference	–	4913.59 ± 4266.90	Reference	–
G3b	4407.83 ± 3238.75	564.82	0.299	5953.11 ± 4620.21	−630.97	0.767	5474.06 ± 5230.63	560.47	0.076
G4	6353.90 ± 3551.43	2510.89	< 0.001*	10,862.70 ± 6970.38	4278.62	0.073	10,797.73 ± 8950.33	5884.14	<0.001*
Diabetes Mellitus
No	3352.95 ± 1390.18	2661.82	<0.001*	5598.83 ± 3794.46	3754.28	0.042*	4245.52 ± 3133.92	4170.73	<0.001*
Yes	6014.77 ± 3355.36			9353.10 ± 7340.05			8416.24 ± 7564.27
Dyslipidemia
No	3759.87 ± 1924.76	1054.36	0.003*	7121.05 ± 6438.63	594.69	0.762	5490.22 ± 5624.31	426.26	0.573
Yes	4814.23 ± 3063.93			7715.74 ± 5182.83			5916.48 ± 5368.77
Hypertension
No	3276.24 ± 2057.61	1071.54	0.151	4585.05 ± 4015.54	2970.95	0.412	4334.33 ± 3578.07	1456.31	0.355
Yes	4347.78 ± 2623.82			7556.00 ± 6060.59			5790.64 ± 5587.17
SBP (mmHg)
<140	4603.53 ± 3108.22	−577.52	0.068	7771.54 ± 6105.70	−682.68	0.728	5843.66 ± 5857.02	−321.81	0.703
≥140	4026.00 ± 2091.91			7088.86 ± 5964.83			5587.96 ± 5202.42
DBP (mmHg)
<90	4300.28 ± 2678.46	−35.81	0.953	7309.20 ± 6139.52	1635.26	0.609	5677.93 ± 5539.30	375.43	0.772
≥90	4264.48 ± 1701.44			8944.45 ± 4375.18			6053.37 ± 5237.80
LDL (mg/dL)
<100	4433.17 ± 2307.64	−368.19	0.507	5661.73 ± 3591.88	2750.09	0.151	5551.54 ± 3740.60	242.42	0.756
≥100	4188.65 ± 2772.00			8411.82 ± 6917.72			5793.96 ± 6347.66
HDL (mg/dL)
<60	4049.17 ± 1693.96	258.51	0.667	4723.94 ± 2162.58	3062.91	0.249	5398.59 ± 3199.23	335.73	0.791
≥60	4307.68 ± 2684.53			7786.85 ± 6288.16			5734.59 ± 5690.96
TG (mg/dL)
<200	4206.30 ± 2655.47	303.12	0.464	6847.94 ± 6120.10	2514.69	0.289	5627.57 ± 5565.77	295.08	0.736
≥200	4509.42 ± 2442.16			9362.64 ± 5021.79			5922.17 ± 5303.17
Hemoglobin A1c (%)
<7	5428.80 ± 3159.08	1734.47	0.035*	9840.34 ± 7797.68	−1029.67	0.770	7437.16 ± 7211.25	2898.10	0.120
≥7	7163.27 ± 3494.26			8811.07 ± 7224.23			10,335.26 ± 8015.06
FBG (mg/dL)
<130	3888.79 ± 1871.02	2779.19	<0.001*	6528.22 ± 5178.29	4153.31	0.076	5072.48 ± 4249.67	4443.91	<0.001*
≥130	6667.98 ± 4531.01			10,681.52 ± 7988.23			9516.39 ± 9437.57

Notes: * P-value <0.05. Mean ±SD, mean ± standard deviation.

Abbreviations: DBP, diastolic blood pressure; FBG, fasting blood glucose; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TG, triglyceride; CKD G3a, chronic kidney disease stage G 3a (GFR 45–59 mL/min/1.73 m²); CKD stage 3b, chronic kidney disease stage G 3b (GFR 30–44 mL/min/1.73 m²); CKD G4, chronic kidney disease stage G 4 (GFR 15–29 mL/min/1.73 m²); HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 4 Cost Model of Chronic Kidney Disease Treatment

	Unstandardized Coefficients		t	Sig.	95% Confidence Interval for B
	B	SE			Lower Bound	Upper Bound
Constant	−5072.638	924.560	−5.487	<0.001	−6895.557	−3249.720
Length of stay	2191.776	65.023	33.708	<0.001	2063.573	2319.980
Ambulatory visit	456.560	50.936	8.963	<0.001	356.131	556.989
Diabetes mellitus	1290.311	303.550	4.251	<0.001	691.813	1888.808
Dyslipidemia	719.157	245.677	2.927	0.004	234.765	1203.550
Serum creatinine	1672.233	290.772	5.751	<0.001	1098.930	2245.536
Fasting blood glucose	9.982	4.259	2.344	0.020	1.584	18.380
Body mass index	86.737	28.777	3.014	0.003	29.998	143.476

Notes: Adjusted R² = 0.906; probability of F-test <0.001

Abbreviations: SE, standard error; Sig., significance.