Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia.
Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
BMC Health Serv Res. 2024 Jul 9;24(1):791. doi: 10.1186/s12913-024-11258-8.
The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.
We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.
Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.
The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.
北领地（澳大利亚）的慢性肾脏病（CKD）负担很高。本研究旨在从医疗保健提供者的角度描述有发生 CKD 风险（如急性肾损伤、糖尿病、高血压和心血管疾病）或患有 CKD 的人群的医疗保健使用情况和相关费用。
我们纳入了 2017 年 1 月 1 日有发生 CKD 风险或患有 CKD 的患者的回顾性队列。接受肾脏替代治疗的患者被排除在研究之外。该研究使用北领地肾脏护理数据库的数据，该数据库涵盖了来自北领地公立医院和初级保健服务的患者，对成本进行核算。描述了为期一年的随访期间的年度医疗保健费用，包括医院、初级保健、药物和检查费用。使用成本预测模型确定与高总年度医疗保健费用相关的因素。
在这项研究中，共纳入了 37398 名患者，其中 23419 人有 CKD 风险因素，13979 人患有 CKD（1 至 5 期，未接受肾脏替代治疗）。研究队列的总体平均（±SD）年龄为 45 岁（±17 岁），其中很大一部分是原住民（68%）。在整个队列中，常见的合并症包括糖尿病（36%）、高血压（32%）和冠状动脉疾病（11%）。有发生 CKD 风险的人群的年度医疗保健费用最低（每人 7958 澳元），CKD 5 期的人群最高（每人 67117 澳元）。住院治疗占所有医疗保健费用的大部分（76%）。导致总年度医疗保健费用增加的预测因素包括 CKD 更晚期别以及合并症的存在。在 CKD 5 期，与无 CKD 的风险人群相比，每人每年的额外费用为+53634 澳元（95%CI 32000 至 89482 澳元，p<0.001）。
即使患者未接受透析，CKD 晚期的总医疗保健费用也很高。仍需要针对 CKD 及相关慢性疾病制定有效的初级预防和早期干预策略。
