OBJECTIVES: The number of patients with chronic kidney disease (CKD) in China is estimated to be 119.5 million, and the quality of life (QOL) for CKD patients in China is also low. The objective of this study was to evaluate the impact of QOL on direct, indirect, and total costs of CKD patients in China’s four metropolises, Beijing, Shanghai, Guangzhou, and Chengdu.

METHODS: The study sample consisted of 401 CKD patients in Beijing, Shanghai, Guangzhou and Chengdu. For each patient, direct, indirect, and total costs related to CKD were calculated. Direct costs included costs of outpatient visits, hospitalization, prescription drugs, labs, and physical therapies. Indirect costs were estimated using transportation and nutrition costs. Total costs were the sum of direct and indirect costs. Patients or their caregivers were interviewed about QOL by using EQ-5D index score (China weight). Three ordinary least squares regression models were conducted, with direct, indirect, and total costs being the dependent variables, respectively. Independent variables in each regression model were QOL and other nine variables (gender, age, insurance status, education level, income level, metropolis, cause of CKD, history of CKD, and type of treatment).

RESULTS: All three regression models were significant (P<0.001). The regression models of direct and total costs explained over 72% of the variance, and the regression model of indirect costs explained 51% of the variance. While controlling for the other nine variables, QOL was a significant negative predictor (P<0.001) in three regression models. In addition, its predictive effect on dependent variables was strong.

CONCLUSIONS: QOL was a strong negative predictor for direct, indirect, and total costs of CKD patients in urban China. Given China’s economic burden of CKD, identifying ways to improve patients’ QOL could result in cost savings.