Abstract
BackgroundTo examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality.MethodsUsing the 2002–2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records—79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models.ResultsTotal costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001).ConclusionsManaging CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.
Highlights
To examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality
What we have is a patient level analysis, but since some patients have multiple cost records, we have a repeated measures dataset; at times, we use the phrase ‘patient record’. These patients were segmented into Dialysis, Transplant and Non-Dialysis Dependent CKD (NDD-CKD) treatment groups based on ICD9CODX classification – International Classification of Disease, 9th Revision
Compared to NDD-CKD patients we found that the Total Cost of treating transplant patients is 44% lower (p < .0267)
Summary
To examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. Chronic kidney disease (CKD) affects approximately 10% of the population worldwide, and millions die each year because they do not have access to affordable treatment [1]. The global costs of CKD quadrupled in the 20 years leading up to 2001 [2] and are expected to continue to increase due to world population growth and aging [3,4,5]. Over 80% of patients who receive treatment for kidney failure live in affluent countries with universal access to health care and large elderly populations [6]. Individuals with stage 5 CKD typically require one of two types of renal replacement therapy, namely dialysis or transplant. These individuals are further classified as having End-Stage Renal
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