Economic Burden Of Moderate Chronic Kidney Disease In Type 2 Diabetes

Data characterizing the economic burden of moderate chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is sparse. We estimated real-world healthcare utilization and expenditures across the spectrum of CKD as determined by estimated glomerular filtration rate (eGFR) in patients with T2D. We used the Truven Healthcare and Claims Dataset from 2009 to 2012 to create a retrospective cohort of patients stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90; 2: 60-89; 3 A: 45-59; 3B: 30-44; 4: 15-29; 5: <15). Index date was defined as the first eGFR laboratory value during a continuous enrolment period of 24 months. Health care expenditures (i.e., total patient and payer paid claims) and utilization (i.e., number of claims or visits) were estimated 12 months post-index date using multivariable regression modelling, adjusting for baseline characteristics 12 months prior to index date. Of 130,098 patients with an index eGFR value and 24 months continuous enrolment, 64,521 (49.59%) were in stage 1, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3 A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4 and 269 (0.21%) were in stage 5. Patients in CKD stages 3 A, 3B, and 4 had 1.32 (95% CI: 1.22, 1.43), 1.59 (95% CI: 1.41, 1.80), and 2.65 (95% CI: 2.23, 3.14) times higher expected rate of diabetes-associated inpatient visits, respectively, compared with CKD stage 1 patients. Patients in CKD stages 3 A, 3B, and 4 had increased incremental total healthcare expenditures of $1,732 (95% CI: $1,109, $2,356), $2,632 (95% CI: $1,647, $3,619), and $6,949 (95% CI: $5,466, $8,432), respectively, compared with CKD stage 1 patients. These real-world data suggest an incremental and significant increase in economic burden in T2D as kidney function declines, starting with moderate (stage 3 A) CKD.