Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort

Abstract

Introduction Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD. Methods Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters. Results Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7–15.9 vs. 7.5–10.5 and 8.7–12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040–35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673–38,315) vs. $17,503 ($7766–39,693) and $16,403 ($7762–34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725–33,443)]. Conclusions Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs. Trial registration ClinicalTrials.gov identifier: NCT04034992. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02010-3.

The costs and cost-effectiveness of different service models of palliative care, focusing on end of life care: A rapid review

“…Nine studies were included which reported the costs of palliative care in hospital settings (Hanson et al, 2008; Isenberg et al, 2017; Kerr et al, 2017; McCarthy et al, 2015; Nathaniel et al, 2015; Pollock et al, 2022; Schneider et al, 2020; Sellars et al, 2019; Tan & Jatoi, 2011). With regards to quality as assessed by the JBI critical appraisal checklist for economic evaluations, n=2 were deemed to be of high quality (McCarthy et al, 2015; Sellars et al, 2019), n=6 were of moderate quality (Isenberg et al, 2017; Kerr et al, 2017; Nathaniel et al, 2015; Pollock et al, 2022; Schneider et al, 2020; Tan & Jatoi, 2011), and n=1 of low quality (Hanson et al, 2008). Most of these studies (n=6) were from the USA, and there were also studies from Australia (Sellars et al, 2019), the Netherlands (Schneider et al, 2020) and the UK (Kerr et al, 2017).…”

Glucose‐lowering treatment pathways of individuals with chronic kidney disease and type 2 diabetes according to the Kidney Disease: Improving Global Outcomes 2012 risk classification

“…DISCOVER CKD (http://clinicaltrials.gov identifier: NCT04034992) is a hybrid, multinational, observational cohort study of individuals with CKD 16 . The study aims to provide contemporary real‐world insights to inform clinical practice and improve understanding of the epidemiology, and clinical and economic burden of CKD 16–18 . The aim of this analysis was to describe the treatment pathways for key glucose‐lowering therapies in individuals with CKD and T2D, using data from two databases within the DISCOVER CKD retrospective cohort.…”

Assessing variance in inpatient hospitalization rates for three major chronic conditions

“…Regarding the analyses of the entire dataset of chronic conditions (output found in Table B), significant relationships at p < .0001 were found between residential status most predictor variables, with the following exceptions: gender (both male and female) and age group (0-17). These significances largely held in the subset of data in the hospitalization dataset with only CKD, COPD, and obesity patients (output in Table C), except that age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) was not significant at p = 0.0035 and payor (Medicare) p = 0.0031; gender remained insignificant.…”

“…28 The median total direct cost of IP care was $431 USD; dialysis was found to be the most expensive component, followed by ward costs, and lastly pharmaceutical costs. 29 This cost-related research is not of high interest due to the socioeconomics of Nigeria versus the United States and the types of healthcare system employed by either (FFS vs. governmentbased); however, what is interesting is the discussion in this article of rural patients. Due to societal inequity and a high percentage of the rural population being impoverished, most rural citizens do not qualify for the government-based insurance, National Health Insurance Scheme (NHIS); even if rural patients were able to enroll in the scheme, the NHIS only covers six renal care sessions per year and does not cover all commonly deemed necessary services.…”

“…Welcome M, The Nigeran health care system: Need for integrating adequate medical intelligence and surveillance systems (2011)29 Adejumo et al, Cost implication of inpatient care of chronic kidney disease patients in a tertiary hospital in Southwest Nigeria(2020) …”