Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study

Ying-Hui Hou; Feng-Jung Yang; I-Chun Lai; Shih-Pi Lin; Thomas Th Wan; Ray-E Chang

doi:10.2196/18716

Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study

JMIR Med Inform. 2020 Dec 17;8(12):e18716. doi: 10.2196/18716.

Authors

Ying-Hui Hou^#¹, Feng-Jung Yang^#^{2

3}, I-Chun Lai^#⁴, Shih-Pi Lin⁵, Thomas Th Wan⁶, Ray-E Chang⁵

Affiliations

¹ Department of Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan.
² Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan.
³ School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Center for Drug Evaluation, Taipei, Taiwan.
⁵ Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁶ Public Affairs PhD Program, College of Health and Public Affairs, University of Central Florida, Orlando, FL, United States.

^# Contributed equally.

PMID: 33331829
PMCID: PMC7775193
DOI: 10.2196/18716

Abstract

Background: The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%.

Objective: The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes.

Methods: Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI's erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions.

Results: For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes.

Conclusions: After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30% to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis.

Keywords: cardiovascular disease; diabetes mellitus; erythropoietin; peritoneal dialysis.

©Ying-Hui Hou, Feng-Jung Yang, I-Chun Lai, Shih-Pi Lin, Thomas TH Wan, Ray-E Chang. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 17.12.2020.