Comparison of In-Hospital Costs in End-Stage Renal Disease Patients Who Received Comprehensive Conservative Management with Advanced Care Planning
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ABSTRACT
Background: End-stage renal disease (ESRD) is a major public health concern in Thailand, contributing to high healthcare costs, especially among patients receiving Renal Replacement Therapy (RRT). Advanced care planning (ACP) can reduce unnecessary interventions and align care with patient preferences, yet uptake among Thai ESRD patients remains low. This study aims to assess whether early ACP, initiated when Karnofsky Performance Status (KPS) >70, is associated with reduced in-hospital costs and first Emergency Department (ED) visits in ESRD patients receiving comprehensive conservative management (CCM) with ACP. .
Methods: A retrospective cohort study was conducted at Pathum Thani Hospital, including 102 ESRD patients who met SPICT criteria and were managed with CCM. Patients were classified into early ACP (KPS > 70) and late ACP (KPS ≤ 70) groups. Outcomes included six-month total in-hospital costs (primary) and first ED visits (secondary). Statistical analyses included the Mann–Whitney U test, generalized linear modeling (GLM), and Cox proportional hazards models.
Results: Among 102 patients who received CCM with ACP, 55 received early ACP. Median in-hospital costs were lower in the early ACP group (8,020 THB vs. 9,300 THB), though not statistically significant (p = 0.1128). However, the adjusted analysis showed a 27% cost reduction with early ACP (95%CI: 1%–46%, p = 0.043). The incidence of the first Emergency Department visit after ACP, between the two groups (4.49 visits per 100 person-months in the early ACP group versus 3.38 visits per 100 person-months in the late ACP group), showed no statistically significant difference (IRR 1.33, 95%CI: 0.57–3.06, p = 0.508). After adjusted analysis using the Cox proportional hazards model, no statistically significant difference was found either (HR 0.91, 95%CI: 0.36–2.30, p = 0.840).
Conclusion: Early ACP was associated with significantly lower treatment costs without increasing the number of first ED visits, suggesting it may be a cost-effective and safe strategy for conservatively managed ESRD patients. Larger studies and the incorporation of home-based palliative care are recommended.
Keywords: Supportive and Palliative Care Indicator Tool (SPICT), Karnofsky Performance Scale (KPS), comprehensive conservative management (CCM)
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