POS-327 THE COST OF END OF LIFE INPATIENT ENCOUNTERS IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE UNITED STATES

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Real-world data reporting healthcare resource utilization (HCRU) and costs associated with end of life inpatient encounters in patients with CKD are limited. Within the DISCOVER CKD observational study of patients with CKD, the PREMIER dataset (Premier Applied Sciences®, Premier Inc) of hospital admissions in the US was analysed, covering the period from 2016 until end of March 2020. Patients were aged ≥18 years at first recorded CKD diagnosis code (ICD-10 code indicating CKD stages 3-5; or kidney failure). Inpatient hospital deaths were identified as inpatient encounters where the discharge status was death. Precise information on cause of death was unavailable, therefore as a proxy these encounters were classified as cardiovascular (CV), kidney failure, or infection-related if a corresponding diagnosis code was recorded as the primary or admitting reason for the encounter, with the remaining unclassified encounters grouped as “other”. The cost (USD) of an inpatient encounter ending in mortality was calculated as the total HCRU incurred during the encounter. The payor for the encounter was identified as either Commercial, Medicaid, Medicare or Other (remaining unclassified or unknown payor types). A total of 237,734 inpatient encounters which ended in mortality were observed with mean (SD) age at death of 74.2 (12.4) years, with the regional distribution of these encounters matching the regional distribution of CKD patients in the dataset (Table 1). Of these encounters, 10.6% were attributed to CV, 1.8% to kidney failure and 32.1% to infection. Given the advanced age of the population, the majority of encounters had Medicare payor coverage. The average (SD) cost of CV related encounters (n=20,779) was $30,874.89 ($73,841.18); kidney failure encounters (n=3,573) $37,588.15 ($274,523.52), and infection-related encounters (n=63,541) was $27,194.42 ($40,980.16). The cost of end of life inpatient encounters was high overall with kidney failure incurring the highest average cost. Despite all patients having CKD, relatively few end of life encounters were attributed to kidney failure, demonstrating the health economic burden of patients with CKD and associated comorbidities.