Economic Impact of IgA Nephropathy for Patients

EP: 1.Advancing IgA Nephropathy Care: Emerging Therapies, Unmet Needs, and Economic Considerations

EP: 2.Introduction to IgA Nephropathy

EP: 3.Pathogenesis of IgA Nephropathy: The 4-Hit Cascade, A Proliferation-Inducing Ligand (APRIL), and cytokines

EP: 4.Diagnosing IgA Nephropathy

EP: 5.Signs and Symptoms of IgA Nephropathy

EP: 6.Challenges in Timely Identification of IgA Nephropathy

EP: 7.Clinical Impact of IgA Nephropathy and Quality of Life

EP: 8.Overview of Treatment Landscape for IgA Nephropathy: Standard of Care and KDIGO Guidelines

EP: 9.Current Treatments for IgA Nephropathy and the 4-Hit Cascade

EP: 10.Gaps in Patient Care for IgA Nephropathy

EP: 11.Emerging Anti-BATH- and Anti-APRIL Therapies

EP: 12.Emerging Therapies: Other Strategies and Important Considerations

EP: 13.The Promise of Emerging Therapies for IgA Nephropathy and Future KDIGO Guidelines

EP: 14.Sequencing and Individualizing Treatments for IgA Nephropathy

EP: 15.Measuring Success in IgA Nephropathy in Clinical Practice

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EP: 16.Economic Impact of IgA Nephropathy for Patients

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.