우리나라의 만성콩팥병으로 인한 사회경제적 부담 추정에 관한 연구 = Socioeconomic Burden of Chronic Kidney Disease in South Korea

국문 초록 (Abstract)

연구목적 : 이 연구는 만성콩팥병의 사회경제적 비용을 추계하기 위해 실시되었다. 연구방법 : 만성콩팥병으로 인한 사회경제적 비용 추정과정은 질병비용연구(cost of illness study)에 바탕을 두었다. 총비용은 직접비용과 간접비용으로 나누어 추계하였다. 추정에 이용된 자료는 건강보험 및 의료급여 진료비와 직접비의료비 및 간접비용 추정에 필요한 각종 통계자료이다. 분석은 가장 최근 연도인 2011년을 기준으로 유병률 접근법에 의한 한 횡단면 분석 prevalence-based cross-sectional design)이 시행되었다. 연구결과 : 연구결과는 2011년 현재 우리나라에서 만성콩팥병으로 인해 발생한 직접 의료비가 1조8,696억 원, 교통비 1,344억 원, 간병비 1,102억 원, 시간비용 2,098억 원, 사망손실 1,746억 원, 장애손실 2조5,233억 원으로 총 5조219억 원인것으로 추정되었다. 추정과정에서의 한계점으로 인해 다소 과소추계되었음을 감안한다면, 실제 만성콩팥병으로 인한 사회경제적 비용은 이 보다 더 클 것으로 예상된다. 또한 다른 주요 만성질환으로 인한 사회경제적 비용과 비교해 보아도 매우 높은 수준임을 알 수 있다. 결론 : 이 연구의 결과는 질병 간 보건의료자원의 효율적인 분배를 결정하고 필요한 자원의 규모를 파악하는데 활용될 수 있을 것이며, 관련 정책을 입안하는 데 중요한 근거자료가 될 수 있을 것이다. 나아가, 만성콩팥병의 예방관리를 위한 보다 많은 노력이 조속히 이루어져야 함을 시사한다.

다국어 초록 (Multilingual Abstract)

Objectives : This study examines the socioeconomic burden of chronic kidney disease (CKD) in Korea. Methods : Overall process of estimating the cost of CKD is based on the cost of illness study. Total cost is divided into both direct and indirect cost. The data used in this study include the 2011 National Health Insurance Claims data, and other secondary databases that are needed to estimate indirect costs. The prevalence-based cross- sectional design approach was used. Results : The results show that socioeconomic burden of chronic kidney disease is alarming in Korea, where total direct and indirect costs associated with CKD are estimated over KRW 5,000 billion (US$ 5 billion) in 2011. Given the limitation of study data and estimation process, the results might have been underestimated. Compared with other major chronic disease, cost of CKD can be considered as substantial. Conclusion : It is suggested that public awareness regarding the significance of CKD should be enhanced. In addition, more prompt attention to prevention and management of CKD need to be paid.

참고문헌 (Reference)

1 대한신장학회, "우리나라 신대체 요법의 현황"

2 통계청, "사망원인통계" 2011

3 안학준, "만성신부전증(만성콩팥병) 환자최근 5년간 37.1% 증가"

4 국민소득총괄팀, "국민계정리뷰" 한국은행 2012

5 질병관리본부, "국민건강영양조사"

6 경제기획원, "경제활동인구조사" 2011

7 허순임, "건강보험진료비 증가요소의 기여도 분해: 인구구조 변화를 중심으로" 한국사회정책학회 21 (21): 9-33, 2014

8 대한간병사협회, "간병서비스 요금표"

9 Astor BC, "Timing of nephrologist referral and arteriovenous access use : the CHOICE Study" 38 (38): 494-501, 2001

10 Kinchen KS, "The timing of specialist evaluation in chronic kidney disease and mortality" 137 (137): 479-486, 2002

11 Locatelli F, "The importance of early detection of chronic kidney disease" 17 (17): 2-7, 2002

12 Foley RN, "The growing economic burden of diabetic kidney disease" 9 (9): 460-465, 2009

13 Murray CL, "The gloval burden of disease: 2004update" World Health Organization 2008

14 Leonardi M, "The global burden of epilepsy" 43 (43): 21-25, 2002

15 Vupputuri S, "The economic burden of progressive chronic kidney disease among patients with type 2diabetes" 28 (28): 10-16, 2014

16 Nugent RA, "The burden of chronic kidney disease on developing nations : a 21st century challenge in global health" 118 (118): 269-277, 2011

17 김성권, "The Prevalence of Chronic Kidney Disease (CKD) and the Associated Factors to CKD in Urban Korea: A Population-based Cross-sectional Epidemiologic Study" 대한의학회 24 : 11-21, 2009

18 OECD, "Statistics on average effective age and official age of retirement in OECD countries"

19 Coresh J, "Prevalence of high blood pressure and elevated serum creatinine level in the United States : findings from the third National Health and Nutrition Examination Survey(1988‐1994)" 161 (161): 1207-1216, 2001

20 Lorenzo V, "Predialysis nephrologic care and a functioning arteriovenous fistula at entry are associated with better survival in incident hemodialysis patients : an observational cohort study" 43 (43): 999-1007, 2004

21 Thorp ML, "Potential application of the National Kidney Foundation's chronic kidney disease guidelines in a managed care setting" 10 (10): 417-422, 2004

22 Winkelmayer WC, "Late nephrologist referral and access to renal transplantation" 73 (73): 1918-1923, 2002

23 World Health Organization, "International Classification of Functioning Disability and Health: ICF" World Health Organization 2001

24 Kessler M, "Impact of nephrology referral on early and midterm outcomes in ESRD : EPidemiologie de l'Insuffisance REnale chronique terminale en Lorraine(EPIREL) : results of a 2‐year, prospective, community‐based study" 42 (42): 474-485, 2003

25 Caetano ER, "Hypertensive nephrosclerosis as a relevant cause of chronic renal failure" 38 (38): 171-176, 2001

26 Khan SS, "Health care utilization among patients with chronic kidney disease" 62 (62): 229-236, 2002

27 Levin A, "Haemoglobin at time of referral prior to dialysis predicts survival : an association of haemoglobin with long‐term outcomes" 21 (21): 370-377, 2006

28 Gradman AH, "From left ventricular hypertrophy to congestive heart failure : management of hypertensive heart disease" 48 (48): 326-341, 2006

29 Kern EF, "Failure of ICD‐9‐CM codes to identify patients with comorbid chronic kidney disease in diabetes" 41 (41): 564-580, 2006

30 Collins AJ, "Excerpts from the United States Renal Data System 2006 Annual Data Report" 49 (49): A6‐7-S1‐296, 2007

31 Reutens AT, "Epidemiology of diabetic kidney disease" 97 (97): 1-18, 2013

32 Khan S, "Economic burden of chronic kidney disease" 14 (14): 422-434, 2008

33 Sabath E, "Early referral to the nephrologist: impact on initial hospitalization and the first 6 months of continuous ambulatory peritoneal dialysis" 55 (55): 489-493, 2003

34 Avorn J, "Delayed nephrologist referral and inadequate vascular access in patients with advanced chronic kidney failure" 55 (55): 711-716, 2002

35 진동찬, "Current Status of Dialysis Therapy in Korea" 대한내과학회 26 (26): 123-131, 2011

36 Goransson LG, "Consequences of late referral of patients with end‐stage renal disease" 250 (250): 154-159, 2001

37 Barsoum RS, "Chronic kidney disease in the developingworld" 354 (354): 997-999, 2006

38 Centers for Disease Control and Prevention, "Chronic Liver Disease and Cirrhosis"

39 국민건강보험공단, "2011년 건강보험통계연보: 국민건강보험공단" 건강보험심사평가원 2012

40 질병관리본부 장기이식관리센터, "2011 장기이식 통계연보" 보건복지부 2011

41 박민정, "2010년도 건강보험환자 진료비 실태조사" 국민건강보험건강보험정책연구원 2011

42 보건복지부, "2010년 국민의료비추계 및 국민보건계정" 보건복지부 2012