Medicare enrollees with kidney disease have ‘disproportionately higher’ medical costs
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Key takeaways:
- Researchers examined total annual health care costs of health plans and enrollee spending.
- Costs for Medicare Advantage enrollees with kidney disease were up to $15,000 higher than counterparts.
Medicare Advantage enrollees with mildly reduced kidney function and accelerated eGFR decline have disproportionately higher medical costs than other patients, data show.
“Chronic kidney disease is a costly and increasingly prevalent condition that increases the risk [for] cardiovascular disease, kidney failure and death,” Clarissa J. Diamantidis, MD, associate professor of medicine and population health sciences in the division of general internal medicine at Duke University School of Medicine, and colleagues wrote in Kidney Medicine. The purpose of the study was to “estimate the trajectories of kidney function over time and to estimate mean annual total health care costs” for specific subsets of patients with kidney disease, the researchers said.
The cohort review used the OptumLabs Data Warehouse database — which contains a diverse mix of ages, ethnicities and geographical regions — to analyze 421,187 Medicare Advantage enrollees with stage G2 CKD from 2014 to 2017. “Specifically, we obtained deidentified administrative medical and pharmacy claims linked with laboratory results, medical benefit design information and death information,” the researchers wrote.
To qualify for the study, patients required two consecutive eGFR values of 60 to 89 mL/min/1.73 m2 between 3 and 15 months apart, with the second value occurring between 2014 and 2017.
Researchers identified five trajectories of kidney function over time: stable eGFR, slow eGFR decline with a mean eGFR at study entry of 78.6 mL/min/1.73 m2, slow eGFR decline with an eGFR at study entry of 70.9 mL/min/1.73 m2, steep eGFR decline and accelerated eGFR decline.
The first outcome was the “distinct trajectory of kidney function progression, as captured by the change in eGFR over the study period,” the researchers wrote. The second was mean annual total health care costs, “defined as the average sum of medical and pharmacy health plans (payer costs) and enrollee spending (out-of-pocket costs such as copays, deductibles and coinsurance) for inpatient, outpatient, pharmacy and other services,” they wrote.
For the fraction of Medicare Advantage enrollees with an accelerated loss of kidney function (2.8%), medical costs were exorbitant, data showed. That group incurred 5.83% of attributable total expenditures 1 year post-index and 5.92% 2 years post-index.
The total cost of enrollees with accelerated loss of kidney function was about $9,500 to $11,500 higher in the year before the study and $13,000 to $15,000 higher two years after.
The results are “particularly relevant given the early degree of kidney dysfunction ...suggesting that detection, continuous disease monitoring, risk stratification and targeted efforts to mitigate the accelerated loss of kidney function early in the disease course may have a profound impact on both cost and clinical outcomes,” Diamantidis and colleagues wrote.
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