13 May Worsening Kidney Function Associated With Significantly Higher Medical Costs

MedicalResearch.com Interview with:

Shaum Kabadi

Shaum Kabadi
HEOR Director at AstraZeneca

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD.

This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US.

Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend).

MedicalResearch.com: What are the main findings?

Response: The proportion of patients with inpatient hospitalizations and the number of outpatient encounters per member per year increased with CKD stage (p-trend <0.01 for both) after adjusting for baseline demographic and clinical characteristics, and healthcare utilization in the pre-index period. Post-index all-cause healthcare costs were similar for Stages 1 to 3b, increased slightly at Stage 4, and greatly increased at Stage 5 (p-trend <0.01 adjusted for covariates).

MedicalResearch.com: What should readers take away from your report?

Response: This study demonstrated that lower eGFR, indicating worse renal function, was associated with significantly higher healthcare resource utilization and costs in an NDD-CKD US commercially insured population.

Costs for inpatient hospitalization and outpatient encounters other than physician office visits increased significantly with CKD stage. Therefore, prevention of worsening renal function may reduce inpatient hospitalization and outpatient encounter costs.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Additional research is needed to confirm if treatments that slow the progression of CKD result in the cost savings described in this study.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study provides contemporary data on the relationship between renal function and healthcare resource utilization and costs in a recent cohort of NDD-CKD patients.

Disclosures: BW is currently an employee of Janssen Pharmaceuticals and was an employee of HealthCore at the time of the study, VW, DK, HC, and GD are employees of HealthCore. SK, MB, JC, DA, and TP are employees of AstraZeneca.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

2017 NKF Spring Clinical Meetings Abstract

HEALTHCARE COSTS OF NON-DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE BY STAGE IN A COMMERCIALLY INSURED US POPULATION
Bingcao Wu, Mike Bullano, Shaum Kabadi, Julia Catini, Vincent Willey, Trudy Pendergraft, David M. Kern, Haechung Chung, Gaurav Deshpande, Deborah Anzalone

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Last Updated on May 14, 2017 by Marie Benz MD FAAD