Health care resource utilization and the impact of anemia management in patients with chronic kidney disease

London, Robert T.; Solis, Amy; Goldberg, George A.; Wade, Sally; Ryu, Seon-Young

doi:10.1053/ajkd.2002.34912

Cited by 38 publications

(35 citation statements)

References 20 publications

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“…However, those with stage 5 CKD incur substantial costs and these expenses increase with disease progression. [9][10][11][12] Our study showed that nephrologist-based MDC could significantly reduce the temporary use of catheter, the duration of hospitalization, and the total medical costs for patients with stage 5 CKD. Furthermore, we clearly demonstrated that a longer (more than 1 year) MDC program for stage 5 CKD patients could slow the decline of renal function and results in annual medical cost savings.…”

Section: Discussionmentioning

confidence: 71%

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Lei¹,

Lee²,

Hsu³

et al. 2012

Renal Failure

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Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002-2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 AE 1.20 vs. 24.63 AE 1.22 months, p ¼ 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 AE 9,967.22 vs. NTD 160,388.61 AE 16,373.97, p ¼ 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 AE 0.27 mL/min per 1.73 m 2 per year) and had an estimated per-capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.

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Section: Discussionmentioning

confidence: 71%

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Lei¹,

Lee²,

Hsu³

et al. 2012

Renal Failure

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“…The dramatic increase in healthcare charges for polycystic kidney disease patients with eGFR Ͻ 30 ml/min is important but not surprising. While the study sample in this analysis was selected to be free of indications of dialysis or transplantation at baseline, GFR Ͻ30 ml/min is the functional level at which many patients begin preparing for dialysis or transplant and face increased burdens of kidney failure-related complications such as anemia, hypertension, and bone and mineral disorders (24). Renal replacement therapy often begins after GFR falls below 10 to 15 ml/min.…”

Section: Discussionmentioning

confidence: 99%

Renal Function and Healthcare Costs in Patients with Polycystic Kidney Disease

Lentine

Xiao

Machnicki

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Characterizing relationships of kidney function to healthcare costs in polycystic kidney disease has applications for economic evaluations of standard and emerging therapies.Design, setting, participants, & measurements: The administrative records (2003 to 2006) of a private health insurer were examined to identify polycystic kidney disease patients (n ‫؍‬ 1913) from ICD9 diagnosis codes on billing claims. The first available diagnostic claim was assumed as an index date, and baseline estimated GFR (eGFR) was computed using closest serum creatinine value. The associations of eGFR with annualized charges were modeled by nonlinear and linear regression.Results: Medical, pharmacy, and total healthcare costs varied significantly by baseline kidney function, such that mean total annualized charges (unadjusted) were approximately 5-fold higher in patients with eGFR < 15 ml/min compared with those with eGFR > 90 ml/min. After adjustment for age and gender, total charges did not differ significantly among patients with eGFR > 30 ml/min, and but rose precipitously with eGFR < 30 ml/min. Each ml/min decline <30 ml/min predicted approximately $5435 higher adjusted annual charges. Results were similar after adjustment for baseline diabetes and cardiovascular disease as identified in claims, while significantly higher adjusted charges were detected with eGFR ‫؍‬ 31 to 60 ml/min versus >90 ml/min in a subgroup free of diabetes and cardiovascular disease.Conclusions: Healthcare charges are associated with advanced renal dysfunction in polycystic kidney disease patients. Strategies that prevent loss of renal function below 30 ml/min have the potential to generate substantial reductions in medical charges.

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“…Total annual pharmacy charges were $2,910,105, or 4% of the total annual charges ( Table 3). The detailed financial profile of health care service use (total and average charges per utilizing member per month) were previously reported by London et al 37 ; this paper focuses on patterns of care from the clinical perspective.…”

Section: Cost and Resource Utilization Economic Burdenmentioning

confidence: 99%

Examination of Resource Use and Clinical Interventions Associated With Chronic Kidney Disease in a Managed Care Population

London¹,

Solis²,

Goldberg³

et al. 2003

JMCP

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BACKGROUND: The management of chronic kidney disease (CKD) is multifaceted, including monitoring, early diagnosis, and treatment of comorbidities such as diabetes, hypoalbuminemia, and anemia, and initiating timely procedures in preparation for dialysis such as vascular access placement. Presumably, optimal care provided to patients during the predialysis phase will produce a significant impact on morbidity and mortality outcomes.OBJECTIVE: A retrospective analysis was conducted to assess specific factors that may be associated with optimal quality of care for CKD patients during the predialysis phase.METHODS: Health care resource utilization and the occurrence of interventions associated with optimal predialysis care were evaluated with claims data. Predialysis erythropoietin (EPO) therapy, nephrology referrals, and nutritional supplement administration were all examined during the 12 months prior to dialysis.RESULTS: Medical and pharmacy claims from a managed care database were analyzed for 1,936 incident dialysis patients. Of these, 48.7% did not have any interventions associated with optimal care. Only a minority of patients received prescription iron preparations (6.8%), vitamin D (4.0%), and phosphate binders (7.7%). A total of 20.8% patients had a vascular access placement, and 29.8% were in the care of a nephrologist during this same time period. Only 10.5% received predialysis EPO, yet more than 40% were diagnosed with anemia. Of the EPO users, however, 72.4% were also receiving other interventions to appropriately manage CKD.CONCLUSION: These claims-documented results suggest that the lack of EPO use in predialysis patients in a managed care plan may predict overall suboptimal treatment of these patients. There is an apparent need for the proactive management of CKD in a managed care plan to potentially redistribute or reduce health care resource utilization while improving patient outcomes.

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Health care resource utilization and the impact of anemia management in patients with chronic kidney disease

Cited by 38 publications

References 20 publications

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Renal Function and Healthcare Costs in Patients with Polycystic Kidney Disease

Examination of Resource Use and Clinical Interventions Associated With Chronic Kidney Disease in a Managed Care Population

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