Korean J Intern Med.  2018 Nov;33(6):1160-1168. 10.3904/kjim.2018.170.

Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database

• Lee HS
• Ju YS
• Song YR
• Kim JK
• Choi SR
• Joo N
• Kim HJ
• Park P
• Kim SG

• KMID: 2426401
• DOI: http://doi.org/10.3904/kjim.2018.170

Abstract

BACKGROUND/AIMS
The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis.
METHODS
This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access.
RESULTS
The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty.
CONCLUSIONS
The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.

Keyword

Renal dialysis; Arteriovenous fistula; Endovascular procedures; Angioplasty; Administrative claims, healthcare

MeSH Terms

Administrative Claims, Healthcare
Angioplasty
Arteriovenous Fistula
Endovascular Procedures
Humans
Insurance
Insurance, Health*
Kidney Failure, Chronic
Korea
Observational Study
Renal Dialysis*
Renal Insufficiency, Chronic
Republic of Korea