All-cause costs increase exponentially with increased chronic kidney disease stage

Ladan Golestaneh, Paula J. Alvarez, Nancy L. Reaven, Susan E. Funk, Karen J. McGaughey, Alain Romero, Melanie S. Brenner, Macaulay Onuigbo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.

STUDY DESIGN: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Dialysis costs were excluded.

RESULTS: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.

CONCLUSIONS: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.

Original languageEnglish (US)
Pages (from-to)S163-S172
JournalThe American journal of managed care
Volume23
Issue number10
StatePublished - Jun 1 2017

Fingerprint

Chronic Renal Insufficiency
Costs and Cost Analysis
Medicare
Electronic Health Records
Renin-Angiotensin System
Chronic Kidney Failure
Hyperkalemia
Cost of Illness
Health
Glomerular Filtration Rate
Prescriptions
Disease Progression
Comorbidity
Inpatients
Dialysis
Heart Failure
Economics
Databases
Delivery of Health Care

ASJC Scopus subject areas

  • Health Policy

Cite this

Golestaneh, L., Alvarez, P. J., Reaven, N. L., Funk, S. E., McGaughey, K. J., Romero, A., ... Onuigbo, M. (2017). All-cause costs increase exponentially with increased chronic kidney disease stage. The American journal of managed care, 23(10), S163-S172.

All-cause costs increase exponentially with increased chronic kidney disease stage. / Golestaneh, Ladan; Alvarez, Paula J.; Reaven, Nancy L.; Funk, Susan E.; McGaughey, Karen J.; Romero, Alain; Brenner, Melanie S.; Onuigbo, Macaulay.

In: The American journal of managed care, Vol. 23, No. 10, 01.06.2017, p. S163-S172.

Research output: Contribution to journalArticle

Golestaneh, L, Alvarez, PJ, Reaven, NL, Funk, SE, McGaughey, KJ, Romero, A, Brenner, MS & Onuigbo, M 2017, 'All-cause costs increase exponentially with increased chronic kidney disease stage', The American journal of managed care, vol. 23, no. 10, pp. S163-S172.
Golestaneh L, Alvarez PJ, Reaven NL, Funk SE, McGaughey KJ, Romero A et al. All-cause costs increase exponentially with increased chronic kidney disease stage. The American journal of managed care. 2017 Jun 1;23(10):S163-S172.
Golestaneh, Ladan ; Alvarez, Paula J. ; Reaven, Nancy L. ; Funk, Susan E. ; McGaughey, Karen J. ; Romero, Alain ; Brenner, Melanie S. ; Onuigbo, Macaulay. / All-cause costs increase exponentially with increased chronic kidney disease stage. In: The American journal of managed care. 2017 ; Vol. 23, No. 10. pp. S163-S172.
@article{94fccca09c9845c29159bc80f6189bba,
title = "All-cause costs increase exponentially with increased chronic kidney disease stage",
abstract = "OBJECTIVE: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.STUDY DESIGN: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Dialysis costs were excluded.RESULTS: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.CONCLUSIONS: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.",
author = "Ladan Golestaneh and Alvarez, {Paula J.} and Reaven, {Nancy L.} and Funk, {Susan E.} and McGaughey, {Karen J.} and Alain Romero and Brenner, {Melanie S.} and Macaulay Onuigbo",
year = "2017",
month = "6",
day = "1",
language = "English (US)",
volume = "23",
pages = "S163--S172",
journal = "American Journal of Managed Care",
issn = "1088-0224",
publisher = "Ascend Media",
number = "10",

}

TY - JOUR

T1 - All-cause costs increase exponentially with increased chronic kidney disease stage

AU - Golestaneh, Ladan

AU - Alvarez, Paula J.

AU - Reaven, Nancy L.

AU - Funk, Susan E.

AU - McGaughey, Karen J.

AU - Romero, Alain

AU - Brenner, Melanie S.

AU - Onuigbo, Macaulay

PY - 2017/6/1

Y1 - 2017/6/1

N2 - OBJECTIVE: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.STUDY DESIGN: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Dialysis costs were excluded.RESULTS: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.CONCLUSIONS: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.

AB - OBJECTIVE: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.STUDY DESIGN: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Dialysis costs were excluded.RESULTS: The study included 106,050 patients with CKD and 56,761 no-CKD controls (90,302 commercial and 72,509 Medicare overall). Mean annualized all-cause costs increased exponentially with advancing stage, from $7537 (no CKD) to $76,969 (CKD stages 4-5) in the commercial group, and $8091 (no CKD) to $46,178 (CKD stages 4-5) in the Medicare group (P <.001; all comparisons with preceding disease stage). Mean costs for end-stage renal disease (ESRD) patients were $121,948 and $87,339 in the commercial and Medicare groups, respectively. Inpatient costs were the largest contributor to total costs, and their relative contribution increased with advancing CKD.CONCLUSIONS: Cost to US health plans increases exponentially with each CKD stage progression. ESRD costs are even higher. Because readmissions lead to higher costs, efforts to reduce readmissions would result in cost reductions. Furthermore, healthcare reengineering paradigms that manage increasing comorbidities with advancing CKD, including heart failure, diabetes, and hyperkalemia, should offer additional potential for cost reductions.

UR - http://www.scopus.com/inward/record.url?scp=85047895100&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047895100&partnerID=8YFLogxK

M3 - Article

C2 - 28978205

AN - SCOPUS:85047895100

VL - 23

SP - S163-S172

JO - American Journal of Managed Care

JF - American Journal of Managed Care

SN - 1088-0224

IS - 10

ER -