Patients with Idiopathic Membranous Nephropathy: A Real-World Clinical and Economic Analysis of U.S. Claims Data

Abstract

BACKGROUND: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in nondiabetic adults. Approximately one third of patients with MN progress to end-stage renal disease (ESRD), while others may be successfully treated to remission. Patients with MN represent a high-risk population for whom management strategies can alter and improve outcomes. Currently, there is little real-world evidence regarding the burden of MN on health plans.OBJECTIVES: To (a) characterize clinical and economic outcomes during a 1-year time frame among a prevalent cohort of patients with MN and (b) compare the 5% of patients incurring the highest cost with the remaining 95%.METHODS: A retrospective analysis of commercially insured patients was conducted using MarketScan administrative health care claims data from January 1, 2012, to December 31, 2015. Patients were aged ≥ 18 years, enrolled in a fee-for-service plan, and had ≥ 2 medical claims for an MN diagnosis (ICD-9-CM codes 581.1, 582.1, and 583.1). Diagnoses indicating clear secondary causes were excluded wherever possible. Demographics were determined as of the first diagnosis date; clinical characteristics (e.g., MN-specific therapy, complications, and procedures), health care resource utilization (HCRU; inpatient, outpatient including other outpatient and emergency department [ED], and prescriptions), and costs were evaluated for 1 year following MN diagnosis. Total costs and cost distribution (2017 U.S. dollars) were examined using plan-paid and patient-paid amounts. The 95th percentile was used to categorize and compare the subcohorts: high-cost cohort (HCC) patients (top 5%) and non-high-cost cohort (NHCC) patients (the remaining 95%). Descriptive analyses, chi-square tests, and Wilcoxon rank-sum tests were conducted. RESULTS: 2,689 patients were identified (60.0% male, mean age = 46.4 years). Severity and advanced disease were observed in a higher proportion of HCC patients (n = 134) versus NHC patients (n = 2,555) via adverse health outcomes, procedures, and immunosuppressant use. HCC patients used significantly more resources on average than NHCC patients

Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome

“…10-20% of iMN patients may progress to end-stage renal disease (ESRD) [4]. Patients with iMN are significantly burdened with high disease severity and adverse health outcomes, resulting in substantial health care resource utilization and costs [5]. Many reports focused on acute kidney injury (AKI) in NS patients in recent years [6][7][8][9].…”

Consequences of insurance denials among U.S. patients prescribed repository corticotropin injection (Acthar Gel) for nephrotic syndrome

“…Because the denied cohort in our study shows an increased use of CS treatment relative to approved patients, it may be the case that patients denied access to therapeutic alternatives such as RCI are at greater risk for steroid-induced complications. Another recent study has found that NS patients with MN type etiology are significantly burdened with high disease severity and incur substantial HCRU and costs 24 . Further study on the benefits of RCI as an alternative first or second line treatment for NS may help clinicians and payers make decisions that reduce the burden of increased resource use and treatment induced adverse events commonly observed in NS patients.…”

Big Data and Glomerular Disease: Uncovering Common Outcomes of Rare Disease

“…Similar to Go et al others have made use of electronic medical record data in this patient population, including within Kaiser Permanente, 6 MarketScan administrative data, 7 and PEDSnet, a national network of children's hospitals 8 . These studies focused on identifying renal biopsy diagnoses, 6 biopsy in combination with International Classification of Diseases 9 th revision (ICD-9) codes, 8 or ICD-9 codes alone 7 . The inclusive approach used by Go et al to identify nephrotic syndrome associated with three specific glomerular diseases is a different and useful, albeit labor-intensive, approach.…”

“…The use of data from electronic medical records holds great promise for the study of rare diseases, including glomerular disease. Similar to Go et al others have made use of electronic medical record data in this patient population, including within Kaiser Permanente, 6 MarketScan administrative data, 7 and PEDSnet, a national network of children's hospitals 8 . These studies focused on identifying renal biopsy diagnoses, 6 biopsy in combination with International Classification of Diseases 9 th revision (ICD-9) codes, 8 or ICD-9 codes alone 7 .…”