Resource use and patient care associated with chronic kidney disease in a managed care setting

J Manag Care Pharm. May-Jun 2003;9(3):238-47. doi: 10.18553/jmcp.2003.9.3.238.

Abstract

Objective: To describe the resource utilization and care of chronic kidney disease (CKD) patients in a managed care plan.

Methods: This was a retrospective claims analysis of a nationwide managed care medical and pharmacy database from September 1, 1998, to July 31, 2001. Twenty-seven health plans in 19 states distributed across the Northeast, Southeast, Midwest, and Southwest United States were represented in this analysis. CKD patients were identified using ICD-9 CM, CPT-4, and HCPCS codes indicative of dialysis. Patients continuously enrolled for at least 6 months before and 3 months after an initial dialysis event were included in the study. Health care charges and associated clinical information were assessed during 3 time periods: predialysis was from the sixth through the second month before initial dialysis, peridialysis was 30 days before and 30 days after initial dialysis, and postdialysis was the second and third month after initial dialysis. The main outcome measures were total health care charges, primary diagnoses, and diagnosis- related groups (DRGs).

Results: The per-patient-per-month charges were 4,265 dollars in the predialysis period (average for 5 months), 35,292 dollars in the peridialysis period (average for 2 months), and 15,399 dollars in the postdialysis period (average for 2 months). The most common primary diagnosis categories during all time periods were chronic renal failure and congestive heart failure. Similarly, the most common DRGs were related to renal and heart failure. A total of 38.2% of patients did not have an initial nephrologist visit until the first dialysis event. Treatments with nutritional supplements and medications such as angiotensin-converting enzyme inhibitors and erythropoietin were found to be suboptimal.

Conclusion: CKD patients generate significant medical charges during the predialysis period and after initiation of dialysis. Further investigations are warranted to assess the impact of active management of CKD patients on CKD-related health care expenditures in kidney disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care / economics
  • Child
  • Child, Preschool
  • Fees and Charges
  • Health Care Costs*
  • Health Resources / economics*
  • Heart Failure / complications
  • Heart Failure / economics
  • Humans
  • Infant
  • Infant, Newborn
  • Insurance, Health
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / therapy
  • Managed Care Programs / economics
  • Middle Aged
  • Patient Care / economics*
  • Pharmaceutical Services / economics
  • Pharmaceutical Services / statistics & numerical data
  • Physicians / economics
  • Physicians / statistics & numerical data
  • Renal Dialysis / economics*
  • Retrospective Studies
  • United States