Pay-for-performance programme for early CKD: impact on survival and costs in Taiwan
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.
Methods: 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.
Results: 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.
Conclusions: 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.
Key messages: • A nationwide P4P multidisciplinary care programme for early CKD reduced disease progression and was cost-saving over five years.
• Investment in early-stage CKD MDC care offers a scalable model for chronic disease policies in universal health systems.
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BibTeX
@article{wu2026payforperformance,
title = {{Pay-for-performance programme for early CKD: impact on survival and costs in Taiwan}},
author = {H-Y Wu and L-Y Hsu and K-L Chien},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.854},
url = {https://doi.org/10.1093/eurpub/ckag169.854},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Pay-for-performance programme for early CKD: impact on survival and costs in Taiwan
AU - H-Y Wu
AU - L-Y Hsu
AU - K-L Chien
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.854
UR - https://doi.org/10.1093/eurpub/ckag169.854
AB - 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. Methods: 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. Results: 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. Conclusions: 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. Key messages: • A nationwide P4P multidisciplinary care programme for early CKD reduced disease progression and was cost-saving over five years. • Investment in early-stage CKD MDC care offers a scalable model for chronic disease policies in universal health systems.
SN - 1101-1262
SN - 1464-360X
ER -