Opinion
Video
Economic Impact of IgA Nephropathy for Patients
Panelists discuss how immunoglobulin A (IgA) nephropathy progression creates escalating economic burdens for patients through direct health care costs, lost productivity, increasing medication needs, and eventually the overwhelming financial impact of dialysis or transplantation.
Economic Impact of IgA Nephropathy Progression to End-Stage Renal Disease
Direct Medical Costs
Pre–End-Stage Kidney Disease (ESKD) Phase
- Diagnostic expenses: Renal biopsy, laboratory monitoring, and imaging studies
- Medication costs: Renin-angiotensin-aldosterone system inhibitors, immunosuppressants, and supportive medications
- Outpatient care: Nephrology visits increasing in frequency with disease progression
- Hospitalization costs: Management of complications (acute kidney injury, infections)
- Comorbidity management: Treatment of hypertension, cardiovascular disease, and anemia
ESKD Phase
- Dialysis expenses: Approximately $90,000-$100,000 annually per patient
- Hemodialysis: Higher costs for in-center treatment vs home hemodialysis
- Peritoneal dialysis: Generally lower costs but with significant supply expenses
- Vascular/peritoneal access: Creation and maintenance of dialysis access
- Transplantation costs:
- Initial transplant: $150,000-$250,000
- Maintenance immunosuppression: $20,000-$25,000 annually
- Monitoring and complication management
- Increased hospitalization rates: 2-3 times higher than general population
Indirect Economic Burden
- Lost productivity: Average 7-10 work days missed per month on dialysis
- Reduced employment: 71% unemployment rate among working-age patients with ESKD
- Income reduction: Average 60%-70% decrease in household income after ESKD onset
- Early retirement/disability: Premature exit from workforce (average age 50-55 years)
- Caregiver burden: Family members reducing work hours or leaving employment
- Educational impact: Reduced educational attainment for younger patients
Long-Term Economic Consequences
- Career trajectory disruption: Limited advancement opportunities and earnings potential
- Retirement insufficiency: Reduced ability to save for retirement
- Insurance challenges: Difficulty obtaining life, disability, and supplemental health insurance
- Out-of-pocket expenses: Transportation, home modifications, and uncovered medical costs
- Intergenerational economic effects: Impact on children’s educational and economic prospects
Health Care System Impact
- High resource utilization: Patients with ESKD represent < 1% of Medicare beneficiaries but consume 7%-8% of Medicare budget
- Cost-effectiveness gap: Preventive strategies substantially more cost-effective than ESKD management
- Transplant economics: Kidney transplantation becomes cost-effective vs dialysis after 2-3 years
Early intervention and prevention of progression to ESKD represents not only better clinical outcomes but also significant economic value for patients, families, and health care systems.
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