Costs Of Chronic Kidney Disease Research Articles

The direct cost of chronic kidney disease (CKD) reported in Asian countries; a systematic literature review

BackgroundThe direct and indirect costs of chronic kidney disease (CKD) are substantial and increase over time. Concerns regarding our capacity to manage the financial burden that CKD) places on patients, caregivers, and society are raised by its increasing prevalence and progression. Lack of awareness of CKD’s economic effects is a major reason that lawmakers and administrators pay little attention to this chronic illness.ObjectiveWe aimed to analyze the direct burden of CKD across Asian countries and evaluate the main cost drivers among all mentioned cost centers in previous studies.MethodologyRelated works evaluating the expenditures of CKD from the perspective of the patient were interpreted by a thorough search of PUBMED and GOOGLE SCHOLAR.ResultsCountry-wise, in Asia, the direct mean average medical costs in RRT patients were reported in 8 studies as $4574, $18668, $2901, $6848, $16669, $3489, $5945, and $6344 in Singapore, Korea, Taiwan, China, Jordan, Vietnam, Lebanon, and India respectively and the direct mean average medical costs in non-RRT patients were reported in six studies as $3412, $2241, $4534, $290 and $1500 in Singapore, Japan, China, Vietnam, and India respectively.ConclusionHemodialysis is the main cost driver having an average mean cost of $23,358 per patient per year while the average mean cost of disease management is $4977 per patient per year. More research is needed to understand the specific economic challenges disadvantaged populations face, including the impact of income, education, and access to healthcare resources on the financial burden of CKD.

Medical Costs of Chronic Kidney Disease and Type 2 Diabetes Among Newly Diagnosed Heart Failure Patients With Reduced, Mildly Reduced, and Preserved Ejection Fraction

The economic burden of heart failure (HF) is enormous, but studies of HF costs typically consider the disease to be a single entity. We sought to distinguish the medical costs for patients with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). We identified 16,516 adult patients with an incident HF diagnosis and an echocardiogram from 2005 to 2017 in the electronic medical record of Kaiser Permanente Northwest. Using the echocardiogram nearest to the first diagnosis date, we classified patients with HFrEF (ejection fraction [EF] ≤40%), HFmrEF (EF 41% to 49%), or HFpEF (EF ≥50%). We calculated annualized inpatient, outpatient, emergency, pharmaceutical medical utilization and costs and total costs in $2,020, adjusted for age and gender using generalized linear models, with further analysis of the effects of co-morbid chronic kidney disease (CKD) and type 2 diabetes (T2D). For all HF types, 1 in 5 patients were affected by both CKD and T2D, and costs were significantly higher when both co-morbidities were present. Total per-person costs were significantly higher for HFpEF ($33,740, 95% confidence interval $32,944 to $34,536) than HFrEF ($27,669, $25,649 to $29,689) or HFmrEF ($29,484, $27,166 to $31,800), driven by in- and outpatient visits. Across HF types, visits approximately doubled with the presence of both co-morbidities. Due to greater prevalence, HFpEF accounted for the majority of total and resource-specific treatment costs of HF, regardless of the presence of CKD and/or T2D. In summary, the economic burden was greater per HFpEF patient and was further amplified by co-morbid CKD and T2D. HFpEF accounted for the large majority of total HF costs, underscoring the need to implement effective treatments.

Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model

There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Our cohort included 4775 (59.9%) men and 3191 (40.1%) women. Of these, 971 (12.2%) and 6995 (87.8%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: -0.0152, 95% confidence limit: -0.0171 to -0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas.

Estimating the value of sodium-glucose cotransporter-2 inhibitors within the context of contemporary guidelines and the totality of evidence.

To comprehensively estimate the cost-effectiveness of sodium glucose cotransporter-2 (SGLT2) inhibitor usage in the management of type 2 diabetes mellitus (T2DM) at established clinical review points, incorporating the totality of proven health benefits. This study considered the cardio- and reno-protective effects of SGLT2 inhibitors using the Cardiff type 2 diabetes model. Conventional cost-effectiveness evaluations were undertaken for eligible populations at relevant intensification points reflecting the 2022 guidelines versus the 2015 National Institute of Health and Care Excellence (NICE) guidelines; incremental cost-effectiveness ratio lifetime trajectories and timepoints for complete cost-offset were estimated for each pathway. Treatment effects, utility decrements and costs (applied additively and discounted at 3.5%) were sourced from the published literature. For all subpopulations on treatment pathways reflecting the NG28-2022 guidelines, SGLT2 inhibitor introduction was cost-effective, becoming cost-saving between 2 and 16 years post-initiation. Despite increases in pharmacy costs, predicted lifetime costs were lower than for pathways reflecting the NG28-2015 guidelines, driven by a reduction in heart failure hospitalization and chronic kidney disease costs. Incremental gains in quality-adjusted life years (ranging from 0.58-1.12) resulted in dominance for the updated NG28-2022 guidance in all scenarios. Our results show that SGLT2 inhibitors have the potential to lower healthcare costs while improving health outcomes in eligible patient subpopulations.

A Two-Part Model of the Individual Costs of Chronic Kidney Disease

Chronic kidney disease (CKD) affects many lives and has a large impact on health systems around the world. To better understand and predict costs for insurance plan people with CKD in the United States, we built a new model of their individual costs. Our model is the first to explicitly model both the CKD stage transition process and the distribution of costs given those stages. Additionally, it incorporates numerous covariates and comorbidities. We applied the models to two large and rich datasets, one commercial insurance and the other Medicare fee-for-service, totaling about 40 million beneficiary months. We found that the XGBoost models best predict both stage transitions and costs. If XGBoost models are unavailable, a multivariate logistic regression model with regularization to predict stage and a logit-gamma model of the costs given the stage best predicted the people’s health care costs in the next month.

Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: The CaReMe CKD study.

SummaryBackgroundDigital healthcare systems data could provide insights into the global prevalence of chronic kidney disease (CKD). We designed the CaReMe CKD study to estimate the prevalence, key clinical adverse outcomes and costs of CKD across 11 countries.MethodsIndividual-level data of a cohort of 2·4 million contemporaneous CKD patients was obtained from digital healthcare systems in participating countries using a pre-specified common protocol; summarized using random effects meta-analysis. CKD and its stages were defined in accordance with current Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CKD was defined by laboratory values or by a diagnosis code.FindingsThe pooled prevalence of possible CKD was 10·0% (95% confidence interval 8.5‒11.4; mean pooled age 75, 53% women, 38% diabetes, 60% using renin-angiotensin-aldosterone system inhibitors). Two out of three CKD patients identified by laboratory criteria did not have a corresponding CKD-specific diagnostic code. Among CKD patients identified by laboratory values, the majority (42%) were in KDIGO stage 3A; and this fraction was fairly consistent across countries. The share with CKD based on urine albumin-creatinine ratio (UACR) alone (KDIGO stages one and two) was 29%, with a substantial heterogeneity between countries. Adverse events were common; 6·5% were hospitalized for CKD or heart failure, and 6·2% died, annually. Costs for renal events and heart failure were consistently higher than costs for atherosclerotic events in CKD patients across all countries.InterpretationWe estimate that CKD is present in one out of ten adults. These individuals experience significant adverse outcomes with associated costs. The prevalence of CKD is underestimated when using diagnostic codes alone. There is considerable public health potential in diagnosing CKD and providing treatments to those currently undiagnosed.FundingThe study was sponsored by AstraZeneca.

Medical Costs of Chronic Kidney Disease and Type 2 Diabetes Among Newly Diagnosed Heart Failure Patients with Reduced, Mildly Reduced, and Preserved Ejection Fraction

Medical Costs of Chronic Kidney Disease and Type 2 Diabetes Among Newly Diagnosed Heart Failure Patients with Reduced, Mildly Reduced, and Preserved Ejection Fraction

Sustainability of Chronic Kidney Disease Care


 Strategies to contain the cost of chronic kidney disease (CKD) care and to improve patient outcomes were found across the continuum of care, from prevention and early disease management through later-stage interventions such as conservative management, dialysis, and transplantation. A variety of health system strategies, including funding reform, were identified to help support and enable sustainable CKD care.
 For those at risk of CKD or in early stages of the disease, public health interventions to support healthy behaviours and ensure access to primary health care seem crucial to preventing or delaying disease progression.
 For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option.
 From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.

PUK4 General Practitioner Utilization and Costs of Chronic Kidney Disease According to the 2012 KDIGO CKD Classification: A Report from the DISCOVER CKD Retrospective Cohort

The DAPA-CKD Trial, designed to assess the effect of dapagliflozin (a sodium–glucose cotransporter 2 [SGLT2] inhibitor) on adverse kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD), with or without type 2 diabetes reported a significant risk reduction (hazard ratio [95% CI] 0.61 [0.51–0.72]) on these outcomes. Data reporting general practitioner (GP) utilization and cost associated with CKD categorized according to 2012 KDIGO recommendations are scarce. We assessed GP visits and costs in a “DAPA-CKD-like population” (estimated glomerular filtration rate [eGFR] 25–75ml/min/1.73m2 and urine-albumin-creatinine-ratio [UACR] 200–5000mg/g) compared to patients categorized according to KDIGO 2012 recommendations.

MO1050ACCESS TO DIALYSIS IN PUBLIC HOSPITALS FOR CHRONIC KIDNEY DISEASE PATIENTS: RESULTS FROM THE HEMODIALYSIS REGISTRY WAITING LIST AT ARISTIDE LE DANTEC HOSPITAL IN SENEGAL

Abstract Background and Aims The lethality and cost of chronic kidney disease (CKD) management are high in Senegal. The aim of this study was to evaluate the access in dialysis at Senegalese public’s hospitals. Method This was a retrospective cohort during 4 years (2014-2018) from the hemodialysis registry waiting list at Aristide Le Dantec University Hospital. This registry is composed by: a registration form (social survey and doctor's visa); a written letter addressed to hospital director and the national identity card. From this registry, telephone calls were made to collect data relating to mortality and access to dialysis. Results seven hundred fifty-one (751) files were collected. The mean age of the patients was 48.12 ± 15.28 years with a sex ratio of 1.02. The socioeconomic level was low in 85.40% (521/610) and average in 13.61% (83/610). The geographic origin was rural in 11.15%, semi-urban in 07.54% and urban in 81.31%. Ten patients (1.64%) had medical care coverage. On call, 49.70% (373/751) were died before accessing to public dialysis, 29.70% (223/751) had accessed public dialysis and 04.00% (30/751) didn’t yet need dialysis. Hundred twenty-one (16.10%) were unreachable and 0.50% (4/751) was unknown. Conclusion The lethality of CKD was high. Access to dialysis in public hospital remains problematic in Senegal despite its democratization. Additional efforts are needed for effective management of all patients at dialysis stage.

Factors Related to the Prevalenceof Chronic Kidney Disease in Indonesia:An Ecological Study

Previous research has found that the cost of chronic kidney disease is relatively high. This study aims to ecologically analyze the factors relatedto the prevalence of chronic kidney disease in Indonesia.The research conduct ecological analysis using secondary data from the Ministry of Health of the Republic of Indonesia report in 2018. The study takes all provinces as samples. Apart from chronic kidney disease, four other variables analyzed as independent variables were the adherence to taking antihypertensive drugs, dedication to taking anti-diabetic drugs/injections, a habit of drinking soft drinks > 1 time/day, a habit of drinking energy drinks> 1 time/day. Data were analyzed usinga scatter plot.The results showed that the higher the percentage of adherence to taking antihypertensive drugs in a province, the higher the prevalence of chronic kidney disease. The higher the percentage of commitment to taking anti-diabetes medications/injections in a section, the lower the prevalence of chronic kidney disease. The higher the rate of drinking soft drinks>1 timea day, the higher the prevalence of chronic kidney disease. The higher the percentage of regular drinking energy drinks>1 timea day, the higher the prevalence of chronic kidney disease.The study concluded that five independent variables analyzed were related to Indonesia’s prevalence of chronic kidney diseases.

Cost of chronic kidney disease attributable to diabetes from the perspective of the Brazilian Unified Health System.

IntroductionDiabetes is the most common cause of chronic kidney disease, with a high economic impact on health systems.ObjectiveTo estimate the cost of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) attributable to diabetes, stratified by sex, race/skin color, and age, from the perspective of the Brazilian public health system between 2010 and 2016.MethodsPopulation attributable risk (PAR) was calculated from the Brazilian prevalence of diabetes and the relative risk (or odds ratio) of persons with diabetes developing CKD and ESKD as compared to non-diabetic subjects. The variables of interest were sex, race/skin color, and age. A top-down approach was used to measure the direct costs of the disease reimbursed by the Brazilian Ministry of Health, using data from outpatient and inpatient records.ResultsThe cost of CKD and ESKD attributable to diabetes in the period 2010–2016 was US$1.2 billion (US$180 million per year) and trending upward. Female sex, age 65–75, and black race/skin color contributed substantially to the costs of CKD and ESKD (US$475 million, US$63 million, and US$25 million respectively). The clinical procedures accounting for the greatest share of disease-attributable costs are hemodialysis and peritoneal dialysis.ConclusionDiabetes accounted for 22% of the costs of CKD and ESKD. Female sex, age 65–75 years, and black race/skin color were the variables which contributed most to disease-related expenditure. The economic burden of CKD may increase gradually in the coming years, with serious implications for the financial sustainability of the Brazilian public health system.

CS1 - Factors Impacting Direct Costs Of Chronic Kidney Disease Among Chinese Urban Patients In Pre-Dialysis Phase

Chronic kidney disease (CKD) is a common public health problem in China, and the prevalence of CKD is 10.8% with 1.7% in pre-dialysis phase. In addition, the costs are estimated to be 643 billion CNY per year for CKD patients in pre-dialysis phase. The objective of this study was to identify factors impacting direct costs of CKD among Chinese urban patients in pre-dialysis phase. Patients were recruited in China’s four metropolises, Beijing (the capital city), Shanghai (in East China), Guangzhou (in South China), and Chengdu (in West China). The study sample consisted of 281 patients in Stage 3 or 4 of CKD, the pre-dialysis phase. For each patient, direct costs included costs of outpatient visits, hospitalization, prescription drugs, labs, and physical therapies. An ordinary least squares regression model was conducted, with direct costs being the dependent variable. Independent variables were gender, age, insurance status, education level, income level, metropolis (four metropolises, Beijing as the reference group), cause of CKD (ten categories, chronic glomerulonephritis as the reference group), history of CKD, and quality of life (EQ-5D index score, China weight). Quality of life was obtained during interviews with patients or their caregivers. The regression model was significant (P=0.001), and explained 17% of the variance. The significant predictors (P<0.05) of direct costs were metropolis (Chengdu) and cause of CKD (chronic glomerulonephritis and hypertensive renal disease, diabetic kidney disease and hypertensive renal disease, uremia, and other causes). In addition, metropolis (Chengdu) was a strong positive predictor, whereas the predictive effect of cause of CKD was small. Compared with patients in Beijing, patients in Chengdu had significantly higher direct costs. This finding implies health disparity of CKD patients between the two metropolises. Future studies are needed to explore how to reduce such regional disparity.

PUK8 - The Impact of Quality of Life on Costs of Chronic Kidney Disease in China’s Four Metropolises

PUK8 - The Impact of Quality of Life on Costs of Chronic Kidney Disease in China’s Four Metropolises

Socioeconomic Costs of Chronic Kidney Disease: Evidence from Southwest Vietnam

Socioeconomic Costs of Chronic Kidney Disease: Evidence from Southwest Vietnam

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action.

The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease financial pressure. However, costs for CKD are not limited to RRT, but also include nonrenal health-care costs, costs not related to health care, and costs for patients with CKD who are not yet receiving RRT. Even if patients with CKD or ESRD could be given the least expensive therapies, costs would decrease only marginally. We therefore propose a consistent and sustainable approach focusing on prevention. Before a preventive strategy is favoured, however, authorities should carefully analyse the cost to benefit ratio of each strategy. Primary prevention of CKD is more important than secondary prevention, as many other related chronic diseases, such as diabetes mellitus, hypertension, cardiovascular disease, liver disease, cancer, and pulmonary disorders could also be prevented. Primary prevention largely consists of lifestyle changes that will reduce global societal costs and, more importantly, result in a healthy, active, and long-lived population. Nephrologists need to collaborate closely with other sectors and governments, to reach these aims.

The social cost of chronic kidney disease in Italy

This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expenses of low-protein special foods, travel, and formal and informal care. Patients’ and caregivers’ losses of productivity have been estimated as indirect costs using the human capital approach. Costs have been expressed in Euros (2016). Totals of 279 patients in stage 4 and 205 patients in stage 5 have been enrolled. The estimated mean annual social cost of a patient with CKD were €7422 (±€6255) for stage 4 and €8971 (±€6503) for stage 5 (p < 0.05). Direct medical costs were higher in stage 5 as compared to stage 4; direct non-medical costs and indirect costs accounted, respectively, for 41 and 5 % of the total social cost of CKD stage 4 and for 33 and 9 % of CKD stage 5. In Italy, the overall annual social cost of CKD was €1,809,552,398 representing 0.11 % of the Gross Domestic Product. Direct non-medical costs and indirect costs were weighted on the social cost of CKD almost as much as the direct medical cost. Patients, their families and the productivity system sustain the burden of the disease almost as much as the healthcare system.

The Budget Impact of Increased Use of Febuxostat in the Management of Gout: A US Health Plan Managed Care Pharmacy and Medical Costs Perspective

PurposeGout is a chronic disease characterized by the deposition of urate crystals in the joints and throughout the body, caused by an excess burden of serum uric acid (sUA). The study estimates pharmacy and medical cost budgetary impacts of wider adoption by US payers of febuxostat, a urate-lowering therapy (ULT) for the treatment of gout. MethodsA US payer-perspective budget impact model followed ULT patients from a 1,000,000-member plan over 3 years. The current market share scenario, febuxostat (6%) and ULT allopurinol (94%), was compared with an 18% febuxostat market share. Data were implemented from randomized controlled trials, census and epidemiologic studies, and real-world database analyses. An innovation was the inclusion of gout-related chronic kidney disease costs. Cost results were estimated as annual and cumulative incremental costs, expressed as total costs, cost per member per month, and cost per treated member per month. Clinical results were also estimated. FindingsIncreasing the febuxostat market share resulted in a 6.3% increase in patients achieving the sUA target level of <6.0 mg/dL and a 1.4% reduction in gout flares during the 3-year period. Total cost increased 1.4%, with a 49.9% increase in ULT costs, a 1.4% reduction in flare costs, a 1.2% reduction in chronic kidney disease costs, and a 2.8% reduction in gout care costs. The cumulative incremental costs were $1,307,425 in the first year, $1,939,016 through the second year, and $2,092,744 through the third year. By the third year, savings in medical costs offset most of the increase in treatment costs. Impacts on cumulative cost per member per month and cumulative cost per treated member per month followed the same pattern, with the highest impact in the first year and cumulative impacts declining during the 3-year period. The cumulative cost per member per month impact was estimated as $0.109, $0.081, and $0.058 and the cumulative cost per treated member per month impact was estimated as $12.416, $9.207, and $6.625 in the first year, through the second year, and through the third year, respectively. ImplicationsExpanding the febuxostat market share would result in improved clinical outcomes, but with an overall increase in costs over 3 years due to higher costs of treatment. By the third year, savings in medical costs, primarily in chronic kidney disease costs, would offset most of the increase in treatment costs. Expanded use of febuxostat in the treatment of all gout patients, independent of renal impairment status, should be considered based on improved clinical outcomes and longer-term medical cost savings associated with these improved outcomes.

Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis.

to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151) was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

PUK15 - The Social Cost Of Chronic Kidney Disease In Italy

PUK15 - The Social Cost Of Chronic Kidney Disease In Italy