Excess healthcare costs in patients with autosomal dominant polycystic kidney disease by renal dysfunction stage

Abstract

Aim

To build upon previous outdated studies by comprehensively assessing the direct healthcare burden of autosomal dominant polycystic kidney disease (ADPKD).

Materials and methods

Patients with ≥2 diagnoses for ADPKD (ADPKD cohort) were identified in the US fee-for-use IBM Truven Health Analytics MarketScan Commercial Claims and Encounters and IBM Truven Health Analytics MarketScan Medicare Supplemental databases (01 January 2015–31 December 2017) and matched (1:3) to controls without ADPKD (non-ADPKD cohort). The index date was the last calendar date followed by 12 months continuous enrollment (study period). Patients with ADPKD were stratified into one of seven mutually exclusive groups based on chronic kidney disease (CKD) stages (I–V), end-stage renal disease requiring renal replacement therapy (ESRD-RRT), and unknown stage.

Results

During the 12-month study period, patients with ADPKD incurred significantly higher total healthcare costs than those without ADPKD (mean cost difference = $22,879 per patient per year [PPPY]; p < .001). Besides CKD stages I and II, total healthcare cost differences increased as patients progressed beyond CKD stage III, with the greatest difference observed among patients with ESRD-RRT. Total healthcare cost differences between cohorts were more pronounced in subgroups of patients with hypertension ($29,347) and with high risk of rapid progression ($39,976). Similar results were observed in the Medicare Supplemental population, with a total mean cost difference of $42,694 PPPY (p < .001); cost difference was also higher in the hypertension ($46,461 PPPY) and high risk of rapid progression ($45,708 PPPY) subgroups.

Limitations

Results may not be representative of the overall ADPKD US population; CKD stage was based on diagnosis and procedure codes; criteria used to identify ADPKD at risk of rapid progression did not rely on laboratory values; there may be billing inaccuracies and omissions in health insurance claims data.

Conclusions

This study demonstrated the substantial healthcare costs associated with ADPKD, which increased as patients progressed through more severe CKD stages.

Keywords:

• Medicare
• commercial
• autosomal dominant polycystic kidney disease
• rapid progression
• healthcare costs

JEL Classification Codes:

• H51 – Government Expenditures and Health
• H5 – National Government Expenditures and Related Policies
• H – Public Economics
• H50 – General
• H5 – National Government Expenditures and Related Policies
• H – Public Economics
• H00 – General
• H – Public Economics
• I15 – Health and Economic Development
• I1 – Health
• I – Health
• Education
• and Welfare

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. The study sponsor contributed to and approved the study design, participated in the interpretation of data, and reviewed and approved the manuscript; all authors contributed to the development of the manuscript and maintained control over the final content.

Declaration of financial/other interests

AG, MC, PGS, and YL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Otsuka Pharmaceutical Development & Commercialization, Inc., which funded the development and conduct of this study and manuscript. MS and DO are employees of Otsuka Pharmaceutical Development & Commercialization, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Author contributions

PGS, YL, AG, MS, DO, and MC contributed to the design of the study and interpretation of the data. PGS, YL, AG, and MC contributed to the data collection and data analysis. All authors critically revised the draft manuscript and approved the final content.

Acknowledgements

Medical writing assistance was provided by Christine Tam, an employee of Analysis Group, Inc.

Previous presentations

Part of this analysis was presented at the National Kidney Foundation Spring Clinical Meeting held from 25–29 March 2020 in New Orleans, LA.

Notes

i. MarketScan is a registered trademark of IBM, Armonk, NY, USA.