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:
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.
Media wishing to receive a PDF of this article, please contact MedicalNews@bos.blackwellpublishing.net.
About the Author
Dr. Wendy St. Peter, Pharm.D., FCCP, BCPS is currently Associate Professor with the Department of Pharmaceutical Care and Health Systems at the University of Minnesota College of Pharmacy. Her research interests include evaluating the medical and economic impact of medications, diseases and disease management programs on patients with chronic kidney disease (inlcuding end-stage renal disease) and nationally at the level of the Centers for Medicare and Medicaid Services (CMS). St. Peter has served a term on the Editorial Board of the Pharmacotherapy Self-Assessment Program (PSAP) and was also a preceptor for the ASHP Clinical Dialysis Traineeship Program. She has been appointed to the Minnesota Department of Human Services Drug Utilization Review Board. Dr. St. Peter can be reached for questions and interviews at 612-347-7752 or wstpeter@nephrology.org. Rebecca Lentz, Director of Communications at the University of Minnesota College of Pharmacy can be reached at 612-624-7654.
About Kidney International
Kidney International, published on behalf of the International Society of Nephrology, is one of the most cited journals in nephrology. Kidney International delivers current laboratory and clinical research on renal medicine. This peer-reviewed, leading international journal is the most authoritative forum for renal science and medicine. Kidney International continues to be a vital source of information for researchers around the world. For additional information on the journal, please visit www.blackwellpublishing.com/kid.
About the International Society of Nephrology
The International Society of Nephrology (ISN) is committed to the worldwide advancement of education, science and patient care in nephrology. This goal is achieved by means of the Society's journal, the organization of international congresses and symposia, and various outreach programs around the world. The ISN acts as an international forum on nephrology for leading nephrologists as well as young investigators, from both developed and emerging countries. Further information is available at www.isn-online.org.
About Blackwell Publishing
Blackwell Publishing is the world's leading, independent society publisher with offices in the US, UK, Japan, Denmark, Australia, and Germany. Blackwell publishes over 700 journals in partnership with more than 550 academic and professional societies. For more information, please visit www.blackwellpublishing.com.
Journal
Kidney International