Medicare's CKD Bill: $49 Billion a Year

Published: Aug 2, 2013

By Cole Petrochko, Staff Writer, MedPage Today

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

Action Points

·         Note that this analysis of a large national sample revealed that chronic kidney disease (CKD) expenditures are high, and increase as the disease progresses.

·         Be aware that these estimates may not reflect the true cost of care as they exclude drug and nursing home costs.

Estimates for Medicare expenditures in chronic kidney disease (CKD) show costs rise as the disease worsens, topping out at over $12,000 per person and totaling $49 billion annually, researchers found.

In 2010 dollars, per-person Medicare expenditures associated with stage IV chronic kidney disease were an estimated $12,700 for a year of treatment, according to Amanda Honeycutt, PhD, of Research Triangle International in Research Triangle Park, N.C., and colleagues.

Among moderate-stage CKD patients, Medicare costs for treatment came in at an estimated $1,700 a year for patients with stage II disease and $3,500 for patients with stage III disease, they wrote online in the Journal of the American Society of Nephrology.

In 2009, 6% of the Medicare budget was spent on treating patients with end-stage renal disease -- a sum of $29 billion. However, data on expenditures for early-stage renal disease is limited, although numbers from the 2011 U.S. Renal Data System showed that Medicare spending on adults ages 65 and older was $20,432 per person annually.

The authors analyzed costs associated with different stages of chronic kidney disease through laboratory data on 4,148 patients from the National Health and Nutrition Examination Survey (NHANES) and Medicare claims.

The majority of patients sampled had no chronic kidney disease (2,539), 161 had stage I disease, 438 had stage II disease, 938 had stage III disease, and 56 had stage IV disease. The mean patient age was 72, and a large portion had one or more comorbid conditions, including cancer among 21%, arthritis in 45%, and back pain in 24%.

Coronary heart disease was also common among those with chronic kidney disease, and prevalence increased with disease stage, the authors noted.

For patients with chronic kidney disease, annual per-capita average overall medical spending was:

·         $9,200 for patients with stage I disease

·         $7,900 for patients with stage II disease

·         $9,300 for patients with stage III disease

·         $18,600 for patients with stage IV disease

For patients with no chronic kidney disease, annual per-capita overall spending was $6,100.

When breaking out annual per-patient costs specifically associated with chronic kidney disease, the authors found the results also varied by stage, from an average of $1,600 at stage I to $12,700 in stage IV, though the authors noted that stage I spending was "not significantly different from zero."

Total annual spending for patients with chronic kidney disease in Medicare was estimated to be $4.6 billion at stage II, $37.2 billion for stage III, and $7.2 billion for stage IV, for an estimated total of about $49 billion each year.

These findings indicate that preventive measures in developing chronic kidney disease may be associated with a wealth of cost savings in later life, and early identification of the condition may help prevent costs associated with later-stage disease, the investigators concluded.

The authors noted that the study was limited by care reimbursed by Medicare in estimates and exclusions for drug and nursing home costs and inability to identify persistent microalbuminuria through NHANES.

The study was supported with a Centers of Excellence in Health Promotion Economics grant.

The authors declared no conflicts of interest.

Primary source: Journal of the American Society of Nephrology
Source reference: Honeycutt AA, et al "Medical costs of CKD in the Medicare population" J Am Soc Nephrol 2013; DOI: 10.1681/ASN.2012040392.

http://www.medpagetoday.com/Nephrology/GeneralNephrology/40811?xid=nl_mpt_DHE_2013-08-03&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g350341d0r&userid=350341&email=john@thebrokerageinc.com&mu_id=5344066