Currently Viewing:
Supplements All-Cause Costs Increase Exponentially with Increased Chronic Kidney Disease Stage
Currently Reading
All-Cause Costs Increase Exponentially with Increased Chronic Kidney Disease Stage
Ladan Golestaneh, MD, MS; Paula J. Alvarez, RPh, MPH, MBA; Nancy L. Reaven, MA; Susan E. Funk, MBA, FACHE; Karen J. McGaughey, PhD; Alain Romero, PhD; Melanie S. Brenner, PharmD, BCPS; and Macaulay On

All-Cause Costs Increase Exponentially with Increased Chronic Kidney Disease Stage

Ladan Golestaneh, MD, MS; Paula J. Alvarez, RPh, MPH, MBA; Nancy L. Reaven, MA; Susan E. Funk, MBA, FACHE; Karen J. McGaughey, PhD; Alain Romero, PhD; Melanie S. Brenner, PharmD, BCPS; and Macaulay On
Objective: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.

Study Design: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with ≥90 days in ≥1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and ≥65 years (Medicare). Dialysis costs were excluded.

Results: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.

Conclusions: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.

Am J Manag Care. 2017;23:-S0
Chronic kidney disease (CKD) is a common disorder and has become a major public health concern in the United States, affecting an estimated 13.6% of the adult population.1,2 Simulation models predict that CKD prevalence in adults aged ≥30 years will increase to 14.4% by 2020 and 16.7% by 2030.3 CKD patients, even in early disease stages, carry a disproportionate burden of cardiovascular morbidity, mortality, healthcare utilization, and costs.4-10

The economic burden of CKD is substantial. According to the US Renal Data System, in 2013 among fee-for-service Medicare patients, total medical costs were $50.4 billion for CKD (excluding end-stage renal disease [ESRD]), and another $30.9 billion for the ESRD patient population.2 In multiple studies, costs for CKD patients were higher than for those without CKD, matched for age and comorbidity, with costs increasing by disease stage and presence of comorbid diabetes mellitus (DM).11-14 Data from commercial insurance databases show that both inpatient (IP) and outpatient (OP) costs contribute significantly to total CKD costs.11

Clinical practice guidelines published by the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative, and more recently by Kidney Disease: Improving Global Outcomes, classify CKD by its stage of severity and provide specific therapeutic recommendations for reducing disease progression.15-17 Several interventions addressing potentially modifiable risk factors have been associated with decreased healthcare utilization in the CKD population, including use of renin-angiotensin-aldosterone inhibitors (RAASis), correction of volume overload, and proper nutrition.12,18 However, rates of attainment of recommended blood pressure targets and other treatment goals remain low.19,20

In this study, we used a large electronic medical records (EMR) database to evaluate all-cause costs, as well as factors contributing to costs, at progressive CKD stages. We hypothesized that all-cause costs increase by CKD stage, and we hoped to identify major cost drivers to recognize opportunities for cost reductions. We further hypothesized that other factors, such as hyperkalemia, may contribute to cost independently through increased and repeated laboratory testing, more frequent provider office visits, as well as subsequent hospitalizations.



 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!