Kim YE, et al. J Korean Med Sci. 2019 Feb;34(11):e75. https://doi.org/10.3346/jkms.2019.34.e75

Jo MW, et al. J Korean Med Sci. 2020 Mar;35(21):e199. https://doi.org/10.3346/jkms.2020.35.e199

Background Determining the cost of a disease is one of the approaches to estimate the burden of the disease. This study was aimed to estimate the socioeconomic burden of chronic kidney disease (CKD) by CKD stages and treatment strategies in Korea. Methods This was a population-based study designed to estimate the cost of CKD according to CKD stages and treatment strategies from a societal perspective in Korea using multiple data sources. Costs of CKD stages III, IV, and V, hemodialysis (HD), and peritoneal dialysis (PD) were estimated with a prevalence-based method. Costs of kidney transplantation (KT) and post kidney transplantation were estimated using an incidence-based method. Costs consisted of direct medical cost, productivity loss cost due to hospitalization and outpatient visit, caregiver cost, and transportation cost. Results Direct medical cost per year per patient with CKD stages III, IV, and V were 1205, 1963, and 8035 Euros, respectively. Direct medical cost per year per patient receiving HD and PD was 34,554 and 25,806 Euros, respectively. Medical cost per year per KT patient was 68,798 Euros. Direct medical cost which accounted for 70% of the total cost of CKD IV and 87% of the total cost of post KT. Cost associated with productivity loss was approximately 8–20%. Conclusions Our findings could be useful for evaluating cost-effectiveness of various CKD interventions including the screening strategy. This study also emphasizes a remarkable increase in the socioeconomic burden associated with the progression of CKD in patients.

Aim: Although a National Health Screening Program (NHSP) for chronic kidney disease (CKD) has been implemented in Korea since 2002, its cost‐effectiveness has never been determined. This study aimed to estimate the cost‐utility of NHSP for CKD in Korea.Methods: A Markov decision analytic model was constructed to compare CKD screening strategies of the NHSP with no screening. We developed a model that simulated disease progression in a cohort aged 20–120 years or death from the societal perspective.Results: Biannual screening starting at age 40 for CKD by proteinuria (dipstick) and estimated glomerular filtration ratio had an ICUR of $66 874/QALY relative to no screening. The targeted screening strategy had an ICUR of $37 812/QALY and $40 787/QALY for persons with diabetes and hypertension, respectively. ICURs improved with lower cost strategies. The most influential parameter that might make screening more cost‐effective was the effectiveness of treatment on CKD to decrease disease progression and mortality.Conclusions: The Korean NHSP for CKD is more cost‐effective for patients with diabetes or hypertension than the general population, consistent with prior studies. Although it is too early to conclude the cost‐effectiveness of the Korean NHSP for CKD, this study provides evidence that is useful in evaluating the cost‐effectiveness of CKD interventions.

The sociodemographic index (SDI), a composite index per capita income, educational attainment, and total fertility rate in a country, can indicate whether the country’s burden of disease varies depending upon its level of socioeconomic development. This study identified the subnational SDI and disease burden of South Korea based on the country’s overall SDI, using national representative data. The burden of disease was measured using disability-adjusted life years (DALY) with an incidence-based approach. We used National Health Insurance Services claims data to estimate the years lived with disability (YLD) and cause-of-death statistics to estimate the years of life lost (YLL). Indicators of subnational SDI were also extracted. The Korean subnational SDIs for 250 regions were correlated with YLL, YLD, and DALY for the year 2016. The correlation between SDI and YLL was stronger in big cities than in medium areas and small areas. Moreover, the higher the SDI, the higher the coefficient. The SDI should be used as a standard for interpreting and comparing regions’ disease burden at the subnational level.

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.