The societal economic burden of autosomal dominant polycystic kidney disease in the United States

Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases characterized by progressive development of renal cysts and numerous extra-renal manifestations, eventually leading to kidney failure. Given its chronic and progressive nature, ADPKD is expected to carry a substantial economic burden over the course of the disease. However, there is a paucity of evidence on the impact of ADPKD from a societal perspective. This study aimed to estimate the direct and indirect costs associated with ADPKD in the United States (US). Methods: A prevalence-based approach using data from scientific literature, and governmental and nongovernmental organizations was employed to estimate direct healthcare costs (i.e., medical services, prescription drugs), direct non-healthcare costs (i.e., research and advocacy, donors/recipients matching for kidney transplants, transportation to/from dialysis centers), and indirect costs (i.e., patient productivity loss from unemployment, reduced work productivity, and premature mortality, caregivers' productivity loss and healthcare costs). The incremental costs associated with ADPKD were calculated as the difference between costs incurred over a one-year period by individuals with ADPKD and the US population. Sensitivity analyses using different sources and assumptions were performed to assess robustness of estimates and account for variability in published estimates. Results: The estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with ADPKD. In the base scenario, direct healthcare costs accounted for $5.7 billion (78.6%) of the total $7.3 billion costs, mostly driven by patients requiring renal replacement therapy ($3.2 billion; 43.3%). Indirect costs accounted for $1.4 billion (19.7%), mostly driven by productivity loss due to unemployment ($784 million; 10.7%) and reduced productivity at work ($390 million; 5.3%). Total excess direct non-healthcare costs were estimated at $125 million (1.7%). Conclusions: ADPKD carries a considerable economic burden, predominantly attributed to direct healthcare costs, the majority of which are incurred by public and private healthcare payers. Effective and timely interventions to slow down the progression of ADPKD could substantially reduce the economic burden of ADPKD.

Regional variations in prevalence and severity of autosomal dominant polycystic kidney disease in the United States

“…The recent Food and Drug Administration (FDA) approval of disease-modifying therapy for ADPKD patients at risk of rapid progression will help support the complex management of these high-risk patients [31]. Timely identification of these patients is of utmost importance as initiating treatment has been shown to slow the rate of decline in kidney function [32], which may help to reduce the substantial burden associated with ADPKD [33].…”

Predicting the number of citations of polycystic kidney disease with 100 top-cited articles since 2010: Bibliometric analysis

“…This can be attributed to the fact that the US spent many research grants on PKD. A study [29] reported that the estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with PKD. There were 37 journals in the T100PKDs.…”

Emerging therapies for autosomal dominant polycystic kidney disease with a focus on cAMP signaling

“…Unrelenting cyst growth causes kidney enlargement and functional decline, associated with hypertension, cyst hemorrhage, gross hematuria, nephrolithiasis, cyst infection, pain, and reduced quality of life. The total annual costs attributed to ADPKD in the United States were estimated to be $7.3 to $9.6 billion in 2018 (Cloutier et al, 2020). Direct healthcare costs accounted for $5.7 billion (78.6%), mostly driven by renal replacement therapy ($3.2 billion; 43.3%).…”