Health Care Resource Use and Cost Burden of Chronic Kidney Disease in Patients With Chronic Liver Disease: A Real‐World Claims Analysis

Abstract

Chronic Liver Disease (CLD) is associated with an increased risk of chronic kidney disease (CKD). However, the health care burden of CKD in the CLD spectrum is unknown. We aimed to evaluate the health care use and cost burdens associated with CKD in patients with CLD in the United States by using real-world claims data. We analyzed data from the Truven Health MarketScan Commercial Claims database from 2010 to 2015. A total of 19,664 patients with CLD with or without comorbid CKD were identified using International Classification of Diseases, Ninth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific unadjusted and adjusted health care parameters were analyzed for the 12 months following an index date selected at random to capture whole disease burdens. In CLD, comorbid CKD was associated with a higher annual number of claims per person (CKD vs. no CKD, 69 vs. 55) and higher total annual median health care costs (CKD vs. no CKD, $21,397 vs. $16,995). A subanalysis stratified by CKD category showed that health care use and cost burden in CLD increased with disease stage, with a peak 12-month median cost difference of $77,859 in patients on dialysis. The adjusted per person annual health care cost was higher for CKD cases compared to controls ($35,793 vs. $24,048, respectively; P < 0.0001). Stratified by the type of CLD, the highest between-group adjusted cost differences were for cirrhosis, viral hepatitis, hemochromatosis, and nonalcoholic fatty liver disease. Conclusion: CKD is a cost multiplier in CLD. The CKD health care burden in liver disease differs by the type of CLD. Improved CKD screening and proactive treatment interventions for at-risk patients can limit the excess burden associated with CKD in patients with CLD. (Hepatology Communications 2020;4:1404-1418).

Costs of multimorbidity: a systematic review and meta-analyses

“…While five studies had explored a wide range of disease combinations from the population or sub-population level [ 48 , 55 , 60 , 66 , 70 ], the majority of studies focused on one [ 33 , 41 , 43 , 52 , 53 , 56 , 59 , 65 , 71 – 88 ] or several disease combinations relating to an index disease of interest [ 40 , 42 , 49 – 51 , 54 , 57 , 58 , 60 – 62 , 67 – 69 , 73 , 89 – 103 ].…”

Estimating health spending associated with chronic multimorbidity in 2018: An observational study among adults in the United States

“…Related, the study design only allows for non-causal interpretation of the results. Fourth, while our list of chronic conditions, as well as the approach of diagnosing chronic conditions, follow the approach set by the CMS [ 2 , 43 ], there may be a more precise definition of categorizing diseases as chronic that are more suitable. We also do not include injuries and non-chronic conditions, some of which might have large impacts on spending.…”

Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

“…Chronic kidney disease(CKD) is defined as kidney damage or a GFR<60 ml/min/1.73 m 2 for a period longer than 3 months ( Drawz and Rahman, 2015 ). Patients with the following diagnosis were classified into chronic liver disease (CLD) group: liver transplant, cirrhosis, fatty liver disease, HBV, HCV, and autoimmune liver disease ( Rustgi et al, 2020 ). The 60-day mortality is defined as an all-cause death ratio within 60 days since the diagnosis of CDI.…”