Cost of Care for Patients with Diabetic Kidney Disease in Veterans Health Administration

Introduction: Diabetic kidney disease (DKD) represents a substantial burden on the Veterans Health Administration (VHA). We calculated the cost of DKD care for US Veterans from the healthcare system perspective. Methods: Veterans with type 2 diabetes (T2D) in 2015-2021 were identified using diagnosis codes, prescription records, and problem lists. We identified prevalent and incident DKD stages based on urine albumin, urine protein, and eGFR, and following the Kidney Disease Improving Global Outcome definitions. Aggregate all-cause monthly healthcare costs per patient for managing each DKD stage (ie, stages 1 through 5) were estimated by summing patient-level VHA costs in incident DKD stages from January 2018 until December 2021. Summary statistics include descriptive median and interquartile ranges of per-patient per-month [PPPM] cost. All costs were inflated to 2022 US dollars (USD) based on the Consumer Price Index of all items for urban consumers. Results and Conclusion: Out of two million US Veterans with T2D, we identified 401,214 DKD patients with 1+ incident stage progression in the follow-up period. Median PPPM all-cause healthcare cost increased exponentially from $748 at Stage 1 to $2,661 at Stage 5 (Figure). Interventions targeting patients with rapid DKD progression could markedly decrease the burden of DKD in US Veterans. Disclosure K.Kim: Research Support; Renalytix, GRAIL (acquired by Illumina in 2021), AstraZeneca. J.L.Crook: None. C.S.Lu: None. R.E.Nelson: None. H.Nyman: None. J.Lafleur: Research Support; Renalytix, Genentech, Inc., Novartis Pharmaceuticals Corporation.