Faster loss of kidney function linked with increased Medicare Advantage health care costs
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Key takeaways:
- Patients who experienced accelerated loss of kidney function had higher costs than those with slower kidney disease progression.
- Early detection may improve cost and clinical outcomes.
Patients with chronic kidney disease who experience accelerated loss of kidney function are likely to have higher health care costs than patients who lose function at a slower rate, according to data published in Kidney Medicine.
“Patients with reduced kidney function can have different trajectories of kidney function over time. Health care costs may differ depending on whether kidney function remains stable, worsens slowly or worsens rapidly,” Clarissa J. Diamantidis, MD, MHS, from Duke University and colleagues wrote. They added, “The purposes of this study were to estimate trajectories of kidney function over time and to estimate mean annual total health care costs (medical and pharmacy spending by plans and enrollees) of each trajectory for Medicare Advantage enrollees with mildly reduced kidney function.”
In a cohort study, researchers examined data of 421,187 patients with G2 CKD who were enrolled in Medicare Advantage between 2014 and 2017. The mean eGFR at enrollment was 75.9 mL/min/1.73 m2.
Researchers considered the trajectory of kidney function progression and the mean annual total health care costs as the primary outcomes. Using inverse probability weighting and cost history from observed and censored enrollees, researchers calculated the mean annual total costs for each trajectory group for 2 years after enrollment. The costs were also determined for the year prior to study enrollment.
Overall, five trajectories of kidney function emerged from the analysis. Investigators found 22.3% of patients experienced stable eGFR, 30.2% experienced slow eGFR decline with a mean eGFR of 78.6 mL/min/1.73 m2 at baseline, 28.4% experienced slow eGFR decline with eGFR of 70.9 mL/min/1.73 m2 at baseline, 16.3% experienced steep eGFR decline and 2.8% experienced accelerated eGFR decline.
Moreover, patients with accelerated eGFR decline had a mean annual cost of $27,738 vs. the mean $13,498 that all other Medicare Advantage enrollees paid. Although all patients had similar kidney function at study entry, those who experienced accelerated loss of function paid approximately $9,500 to $11,500 more than the other patients in the year before study entry, which increased to $13,000 to $15,000 more 2 years after study entry.
“The findings presented here elucidate progression that targeted intervention might be able to address to mitigate escalating disease and related costs,” Diamantidis and colleagues wrote. “Further, future work should examine health care costs of patients with longer follow-up to understand how costs change as patients progress to CKD stages 3 to 4. There may also be value in future development of predictive models that leverage a richer set of covariates and more complete lab data (including albuminuria).”
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