Bayer Pharmaceuticals, Whippany, NJ. Email:
Am J Manag Care. 2021 Dec;27(20 Suppl):S369-S374. doi: 10.37765/ajmc.2021.88807.
To provide cost estimates for chronic kidney disease (CKD) management and major CKD complications among patients with CKD and type 2 diabetes (T2D).
A retrospective cohort study of 52,599 adults with CKD and T2D using Optum Clinformatics claims data from 2014 to 2019.
Medical costs associated with CKD management, renal replacement therapies (RRTs), major CKD complications (eg, myocardial infarction, stroke, heart failure, atrial fibrillation, and hyperkalemia), and death were estimated using generalized estimating equations adjusting for baseline demographics, complications, and medical costs. Costs for CKD management, RRT, and major CKD complications were assessed in 4-month cycles. Mortality costs were assessed in the month before death.
The estimated 4-month CKD management costs ranged from $7725 for stage I to II disease to $11,879 for stage V (without RRT), with high additional costs for dialysis and kidney transplantation ($87,538 and $124,271, respectively). The acute event costs were $31,063 for heart failure, $21,087 for stroke, and $21,016 for myocardial infarction in the first 4 months after the incident event, which all decreased substantially in subsequent 4-month cycles. The acute event costs of atrial fibrillation and hyperkalemia were $30,500 and $31,212 with hospitalization, and $5162 and $1782 without. The costs associated with cardiovascular-related death, renal-related death, and death from other causes were $17,031, $12,605, and $9900, respectively.
Management of CKD and its complications incurs high medical costs for patients with CKD and T2D. Results from this study can be used to quantify the economic profile of emerging treatments and inform decision-making.
估算慢性肾脏病（CKD）患者伴 2 型糖尿病（T2D）的 CKD 管理和主要 CKD 并发症的成本。
使用 2014 年至 2019 年 Optum Clinformatics 索赔数据，对 52599 例 CKD 伴 T2D 成人进行回顾性队列研究。
使用广义估计方程，根据基线人口统计学、并发症和医疗费用调整，估算与 CKD 管理、肾脏替代疗法（RRT）、主要 CKD 并发症（如心肌梗死、中风、心力衰竭、心房颤动和高钾血症）和死亡相关的医疗费用。每 4 个月评估一次 CKD 管理、RRT 和主要 CKD 并发症的费用。在死亡前一个月评估死亡率的成本。
估计的 4 个月 CKD 管理费用从 I 期至 II 期疾病的 7725 美元到 V 期（无 RRT）的 11879 美元不等，透析和肾移植的额外费用很高（分别为 87538 美元和 124271 美元）。在发病后前 4 个月，心力衰竭的急性事件费用为 31063 美元，中风为 21087 美元，心肌梗死为 21016 美元，此后在随后的 4 个月周期中均大幅下降。心房颤动和高钾血症的急性事件费用为 30500 美元和 31212 美元，包括住院治疗费用，无住院治疗的费用为 5162 美元和 1782 美元。心血管相关死亡、肾脏相关死亡和其他原因导致的死亡的费用分别为 17031 美元、12605 美元和 9900 美元。
CKD 及其并发症的管理给 CKD 伴 T2D 患者带来了高昂的医疗费用。本研究结果可用于量化新兴治疗方法的经济状况，并为决策提供信息。
