Factors associated with increased healthcare costs in Medicare Advantage patients with type 2 diabetes enrolled in a large representative health insurance plan in the US

Slabaugh, S. Lane; Curtis, Bradley; Clore, Gosia; Fu, Haoda; Schuster, Dara

doi:10.3111/13696998.2014.979292

Cited by 32 publications

(23 citation statements)

References 12 publications

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“…Progression of non-dialysis CKD is known to be associated with escalating healthcare costs [6, 8, 22]. In an a analysis of 83,705 adults with type 2 diabetes enrolled in a Medicare Advantage plan, Stage 4 CKD was associated with an incremental cost increase of $33,131 relative to stage 1 or no CKD in the 98 th percentile of total costs [22].…”

Section: Discussionmentioning

confidence: 99%

“…In an a analysis of 83,705 adults with type 2 diabetes enrolled in a Medicare Advantage plan, Stage 4 CKD was associated with an incremental cost increase of $33,131 relative to stage 1 or no CKD in the 98 th percentile of total costs [22]. In a study of Medicare enrollees, CKD was estimated to increase the average Medicare payment for part A by a factor of 12.1 and for part B by a factor of 4.4 among men.…”

Section: Discussionmentioning

confidence: 99%

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Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures

et al. 2017

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BackgroundPrevious studies have documented the high costs of non-dialysis dependent chronic kidney disease (CKD) but out-of-pocket healthcare expenditures remain poorly explored. This study described total direct and out-of-pocket expenditures for adults with non-dialysis dependent CKD and compared expenditures with those for cancer or stroke.MethodsThis study used data from the 2011–2013 Medical Expenditure Panel Survey, a national survey of healthcare expenditures in the U.S. population. Expenditures were determined for adults with the following chronic diseases: CKD defined by 585 ICD9 codes (n = 52), cancer (colon, breast or bronchus/lung) (n = 870), or stroke (n = 1104). These represent adults who were aware of their conditions or visited a healthcare provider for the condition during the study period. Generalized linear models were used to estimate the marginal effects of CKD, cancer or stroke on adjusted expenditures compared to adults without CKD, cancer or stroke (n = 72,241) while controlling for demographics and co-morbidities and incorporating the sample weights of the complex survey design.ResultsThe mean age for group with CKD, cancer or stroke was 65.5, 66.1, and 68.2 years, respectively, while mean age for group without CKD, cancer or stroke was 47.8 years. Median values of total direct and out of pocket healthcare expenditures ranged from as high as $12,877 (Interquartile Range [IQR] $5031-$19,710) and $1439 ($688–$2732), respectively, with CKD, to as low as $1189 (IQR $196-$4388) and $226 (IQR $20-$764) in the group without CKD, cancer or stroke. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke.ConclusionsTotal and out of pocket health expenditures for adults with non-dialysis dependent CKD are high and may be equal to or higher than expenditures incurred by adults with cancer or stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0432-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures

et al. 2017

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“…Patients with diabetic nephropathy, especially those with severe stages of nephropathy such as chronic kidney disease and ESRD [12–15], incur higher economic burden compared to those without renal impairment [16–18]. In addition, patients who progress to severe stages of kidney disease experience higher rates of all-cause hospitalization and healthcare resource utilization (HRU) [13], and patients’ incremental costs associated with the progression of chronic kidney disease are significantly higher than those of patients without renal impairment [12, 15]. …”

Section: Introductionmentioning

confidence: 99%

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

et al. 2017

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IntroductionDiabetic nephropathy (DN) is a progressive kidney disease resulting as a complication of diabetes mellitus. This study evaluated the disease progression and economic burden of DN among commercially insured patients with type 2 diabetes in the USA.MethodsThe research design was a retrospective observational study based on healthcare claims data. The Truven MarketScan Databases (2004–2014) were queried for adults with type 2 diabetes with at least one urine albumin test (index, randomly selected) after diagnosis and at least one test after the index. On the basis of the index test, patients were classified into normoalbuminuria, microalbuminuria, or macroalbuminuria groups. Nephropathy-related treatment use was measured in the 6 months after the index, disease progression was assessed from the index to the end of data availability, and annual all-cause and nephropathy-related costs and healthcare resource use (HRU) were assessed up to 2 years from the index. Outcomes were compared between any two groups, controlling for baseline demographics.ResultsA total of 23,235 patients were identified and classified into normoalbuminuria (N = 18,409), microalbuminuria (N = 3863), or macroalbuminuria (N = 963) groups. Patients with albuminuria were more likely to be older, male, and have a higher burden of baseline comorbidities and HRU. Within 6 months following the index, 12–20% of patients with albuminuria were not treated with any relevant recommended treatment. Compared to the normoalbuminuria group, patients with macroalbuminuria had a significantly greater risk of disease progression (hazard ratio [HR] = 1.44), and both albuminuria groups were more likely to require dialysis (HR = 4.23 and 40.14 for micro- and macroalbuminuria, respectively; all p < 0.05). Annual all-cause (2016 US dollars, $3580 and $12,830 higher for micro- and macroalbuminuria vs. normoalbuminuria, respectively) and nephropathy-related ($362 and $3716) costs increased significantly with increasing nephropathy severity, consistent with the trend in increased HRU.ConclusionsDiabetic nephropathy may be undertreated or inappropriately treated. It was also associated with significantly higher costs, HRU, and risk of disease progression among commercially insured patients with type 2 diabetes in the USA.FundingTakeda Development Center Americas, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0256-5) contains supplementary material, which is available to authorized users.

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“…Although some of these disparities are owing to real differences in disease prevalence, the lower prevalence should be more than offset by the disproportionate societal expense of caring for patients with kidney disease. 2,133–135 For example, in 2011, although ESRD patients comprised only 1.4% of the Medicare population, they consumed more than 7% of Medicare resources. 136 Campaigns to increase patient and physician awareness are critical to streamline recruitment to trials of therapies for CKD.…”

Section: Emerging Therapies For Chronic Kidney Diseasementioning

confidence: 99%

Developing Treatments for Chronic Kidney Disease in the 21st Century

Breyer

Suszták

2016

Seminars in Nephrology

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Summary Chronic kidney disease (CKD) is a lethal and rapidly increasing burden on society. Despite this, there are relatively few therapies in development for the treatment of CKD. Several recent costly phase 3 trials have failed to provide improved renal outcomes, diminishing interest in pharmaceutical investment. Furthermore, poor patient, physician, and payer awareness of CKD as a diagnosis has contributed to slow trial enrollment and successful implementation of these trials. Nevertheless, several therapeutics remain in development for the treatment of CKD, including mineralocorticoid-receptor antagonists, sodium/glucose cotransporter 2 inhibitors, anti-inflammatory drugs, and drugs that mitigate oxidative injury. Success of future CKD therapeutic trials will depend not only on improved understanding of disease pathogenesis, but also on improved trial enrollment rates, through increasing awareness of this disease by the public, policy makers, and the greater medical community.

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Factors associated with increased healthcare costs in Medicare Advantage patients with type 2 diabetes enrolled in a large representative health insurance plan in the US

Cited by 32 publications

References 12 publications

Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures

Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

Developing Treatments for Chronic Kidney Disease in the 21st Century

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