Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort.

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Tytuł:: Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort.
Autorzy:: Pollock C; Kolling institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW, 2065, Australia. .
James G; BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK.
Garcia Sanchez JJ; BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK.
Arnold M; BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK.
Carrero JJ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Lam CSP; Department of Cardiology, National Heart Centre, Singapore, Singapore.; Duke-NUS Medical School, Singapore, Singapore.
Chen H; BioPharmaceuticals Business Unit, AstraZeneca, Gaithersburg, MD, USA.
Nolan S; BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK.
Pecoits-Filho R; School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil.; Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
Źródło:: Advances in therapy [Adv Ther] 2022 Mar; Vol. 39 (3), pp. 1432-1445. Date of Electronic Publication: 2022 Feb 03.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: New York : Springer Healthcare Communications, 2008- : Health Communications Inc.
Original Publication: Metuchen, N.J. : Health Communications Inc., c1984-
MeSH Terms:: Inpatients*
Renal Insufficiency, Chronic*/complications
Adolescent ; Aged ; Death ; Female ; Health Care Costs ; Humans ; Medicare ; Retrospective Studies ; United States
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Contributed Indexing:: Keywords: Chronic kidney disease; Costs; End-of-life; Health economics; Mortality; Retrospective
Molecular Sequence:: ClinicalTrials.gov NCT04034992
Entry Date(s):: Date Created: 20220203 Date Completed: 20220315 Latest Revision: 20220507
Update Code:: 20240104
PubMed Central ID:: PMC8810284
DOI:: 10.1007/s12325-021-02010-3
PMID:: 35112306
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Introduction: Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD.
Methods: Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters.
Results: Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7-15.9 vs. 7.5-10.5 and 8.7-12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040-35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673-38,315) vs. $17,503 ($7766-39,693) and $16,403 ($7762-34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725-33,443)].
Conclusions: Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs.
Trial Registration: ClinicalTrials.gov identifier: NCT04034992.
(© 2022. The Author(s).)

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