End-stage renal disease in autosomal dominant polycystic kidney disease: a comparison of dialysis-related utilization and costs with other chronic kidney diseases

Abstract

Background

Autosomal dominant polycystic kidney disease (ADPKD) is the leading inheritable cause of end-stage renal disease (ESRD) and one of the leading causes of ESRD overall. ADPKD patients differ from the overall dialysis population; however, there is little published data regarding health care costs for ADPKD patients on dialysis.

Methods

This retrospective observational cohort study was designed to quantify health care utilization and costs for ADPKD patients with ESRD who received initial services at a single large dialysis organization between January 1, 2007 and December 31, 2009. Parallel results and baseline patient characteristics for control patients with ESRD etiologies other than ADPKD were performed for reference. Dialysis-related utilization and health care costs for patients with ADPKD in ESRD overall and during time horizons that correspond to Medicare-eligibility benchmarks were analyzed. Baseline patient characteristics were described for all patients and included demographics, comorbid illnesses, and clinical characteristics. Dialysis-related utilization, hospitalization rates, and health care costs were considered longitudinally.

Results

Total health care costs for ADPKD patients were high at US$51,048 per patient-year based on the overall analysis. Total health care costs were lower for ADPKD patients than for control patients on dialysis. Patients with ADPKD were generally younger, had a lower Charlson Comorbidity Index, and had lower rates of comorbid conditions, which may have contributed to the lower overall costs seen for patients with ADPKD.

Conclusion

Health care resource utilization and costs for patients with ADPKD in ESRD requiring dialysis were high, and therapeutic interventions that can prevent or delay the progression to ESRD may increase dialysis-free life for patients with ADPKD.

Keywords:

• ADPKD
• chronic kidney disease
• dialysis
• health care costs

Acknowledgments

Editorial support for the preparation of this manuscript was provided by Scientific Connexions, Inc., funded by Otsuka America Pharmaceutical, Inc.

Disclosure

This study was sponsored by Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA. Sandro Rossetti is an employee of Otsuka America Pharmaceutical, Inc.; Christopher M Blanchette and Benjamin Gutierrez were employees of Otsuka Pharmaceutical during the study. Steven Brunelli and Ami Claxton are employees of DaVita Clinical Research, which has received funds from Otsuka America Pharmaceutical, Inc. in connection with conduction of this study. Debosree Roy has no conflicts to disclose. Steven Brunelli has received speaking honoraria from Fresenius Medical Care North America and has been a past member of Amgen and CB Fleet advisory boards and is a current member of Otsuka and Keryx advisory boards; his spouse is employed by AstraZeneca. The authors report no other conflicts of interest in this work.