Older patients with chronic kidney disease are costly as they transition to dialysis
MINNEAPOLIS (June 24, 2004)--The costs of treating Medicare patients with chronic kidney disease remain relatively stable until right before patients begin dialysis, when costs increase significantly, according to a study by University of Minnesota researchers.
Researchers found hospitalizations accounted for the majority of the cost increase in the time frame immediately before patients begin dialysis. The findings surprised researchers because fully insured Medicare patients who receive adequate care should have a smoother--and thus less expensive--transition to dialysis, says Wendy St. Peter, an associate professor at the University of Minnesota College of Pharmacy and lead author on the study. The findings are reported in the July 2004 issue of the journal, Kidney International.
"We believe that optimal management of chronic kidney disease patients may not only extend the time before dialysis is necessary, but it will also reduce future health care expenses, particularly around the start of dialysis," St. Peter says. "Medicare and other health care payers need to understand how expensive it is to care for chronic kidney disease patients who later go on dialysis. Third-party payers also need to understand the importance of identifying and treating patients as soon as possible. This, we hope, will reduce the high costs associated with dialysis."
Estimates put the number of U.S. adults with chronic kidney disease at around 20 million. Medicare claims for patients with end-stage renal disease (the final stage of chronic kidney disease, when dialysis is needed) total more than $16 billion annually. This amount is spent on a relatively small number of patients (about 300,000).
Researchers looked at Medicare claims from 109,321 patients who received care for chronic kidney disease from 1995 to 1998. They looked at the costs associated with caring for chronic kidney disease patients during the two years before they began dialysis and the six months after they started dialysis. Researchers adjusted the dollar amount of the claims for inflation.
The average age of the patient was 75, and 51 percent were males.
The research indicates that Medicare costs for older patients with chronic kidney disease escalate rapidly a few months before needing dialysis to survive. No previous studies have examined costs in a group of elderly patients with chronic kidney disease for such an extensive time period.
The research shows that hospitalization costs were the major cost driver throughout the study. Patients with chronic kidney disease who also had diabetes or cardiovascular disease incurred higher costs compared with those who didn't have other diseases. The researchers concluded that that timely management of chronic kidney disease and other conditions may reduce future hospitalizations and bring down the cost of managing end-stage renal disease.
"Although yet to be proven in a prospective clinical trial, early diagnosis of chronic kidney disease and timely interventions for complications of chronic kidney disease may prevent avoidable morbidity and cost," the authors wrote.
St. Peter says there are three implications of the study:
Sicker patients are being cared for under the Medicare end-stage renal disease program, a trend that will increase costs. Better management of chronic kidney disease and other conditions such as diabetes, hypertension and heart disease may delay the onset of end-stage renal disease and decrease future health care expenses by decreasing hospitalizations. Prospective studies are needed to determine whether spending money up front on preventive therapies and health maintenance in patients with chronic kidney disease will reduce future health care costs.
Many patients with chronic kidney disease have other conditions, including diabetes, hypertension and cardiovascular disease. Researchers examined the effect of those conditions on claims for chronic kidney disease and discovered even higher costs immediately before and after starting dialysis than in patients who did not have these other conditions. This further implies the need for better management of coexisting conditions in patients with chronic kidney disease, St. Peter says.
"If the comorbidity among patients accepted to the end-stage renal disease program continues to increase, the impact on the future cost of the end-stage renal disease program can be substantial and may require a reevaluation of the current Medicare payment system," the researchers wrote.
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