{
  "abstract": "Background: Chronic kidney disease (CKD) is a growing non-communicable disease burden globally and a major public health challenge in Taiwan, which has one of the highest prevalences of dialysis. A national pay-for-performance (P4P) multidisciplinary care (MDC) programme was implemented for early-stage CKD (stages 1-3A). This study evaluates the impact on survival and healthcare costs.\n\nMethods: Using Taiwan’s National Health Insurance claims linked to death registry data, adults diagnosed with stages 1-3A CKD in 2017 were followed until 2022. P4P MDC participants were matched 1:1 to non-participants by age, sex, Charlson comorbidity index score, diabetes, hypertension, and propensity score. Five-year cumulative CKD-related medical costs (US$) and life-years (LYs) gained were measured. Generalized linear regressions with bootstrapping were used to calculate the incremental cost-effectiveness ratio (ICER). A composite renal endpoint (progression to advanced CKD, dialysis, or acute kidney injury) was analyzed using Fine and Gray’s subdistribution hazard models with death as competing risk.\n\nResults: Among 303,024 matched pairs (mean age 66.4 years; 53.8% female; 62.6% with diabetes), the P4P group had a lower risk of composite renal endpoint than non-participants (adjusted subdistribution hazard ratio 0.557, 95% CI 0.549-0.565). The P4P group had lower adjusted CKD-related inpatient costs (−US$203, 95% CI − 212 to − 196) and outpatient costs (−US$20, 95% CI − 21 to − 19). The adjusted ICER was −US$976 per LY gained for inpatient costs (95% CI − 1,019 to − 931) and −US$95 per LY gained for outpatient costs (95% CI − 99 to − 89), indicating programme dominance.\n\nConclusions: The early CKD P4P programme is a cost-effective public health intervention, offering a scalable model for managing the CKD epidemic. These findings support expansion of multidisciplinary P4P frameworks in chronic disease policies.\n\nKey messages: • A nationwide P4P multidisciplinary care programme for early CKD reduced disease progression and was cost-saving over five years.\n\n• Investment in early-stage CKD MDC care offers a scalable model for chronic disease policies in universal health systems.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "name": "H-Y Wu"
    },
    {
      "name": "L-Y Hsu"
    },
    {
      "name": "K-L Chien"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4x3p5navf5z0v.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.854",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697661/",
  "id": "4x3p5navf5z0v",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.854",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "5. Poster Walks"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
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      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "heading",
      "R.4. Poster Walk: Chronic disease, multimorbidity and healthy ageing"
    ],
    [
      "openalex",
      "2727|Chronic Kidney Disease and Diabetes"
    ]
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  "openalex": "W7223689355",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697661/pdf/?tool=EBI",
  "pmcid": "PMC13697661",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/4x3p5navf5z0v.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:40Z",
      "native_id": "PMC13697661",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.854"
    },
    {
      "first_seen": "2026-10-30T12:21:31Z",
      "native_id": "PMC:PMC13697661",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13697661"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Chronic Kidney Disease and Diabetes",
      "subfield": "general"
    }
  ],
  "title": "Pay-for-performance programme for early CKD: impact on survival and costs in Taiwan",
  "title_text": "Pay-for-performance programme for early CKD: impact on survival and costs in Taiwan",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:39Z",
  "url": "https://research.draconitic.com/paper/4x3p5navf5z0v",
  "venue": "The European Journal of Public Health",
  "versions": []
}