Healthcare costs in chronic kidney disease and renal replacement therapy: a population-based cohort study in Sweden

• Published in: BMJ open Vol. 6; no. 10; p. e012062
• Main Authors: Eriksson, Jonas K, Neovius, Martin, Jacobson, Stefan H, Elinder, Carl-Gustaf, Hylander, Britta
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-01-2016; BMJ Publishing Group
• Subjects: Adult; Aged; Ambulatory care; Ambulatory Care - economics; Cohort Studies; Costs; Female; Glomerular Filtration Rate; Health Care Costs; Hospitalization - economics; Hospitals; Humans; Identity; Kidney diseases; Kidney Failure, Chronic - economics; Kidney Failure, Chronic - therapy; Kidney Transplantation - economics; Kidney transplants; Male; Medicin och hälsovetenskap; Middle Aged; National Health Programs; Nephrology; Patients; Peritoneal dialysis; Peritoneal Dialysis - economics; Population; Prescription drugs; Registries; Renal Dialysis - economics; Renal Insufficiency, Chronic - economics; Renal Insufficiency, Chronic - therapy; Renal Medicine; Renal replacement therapy; Renal Replacement Therapy - economics; Sweden; North America; Sweden; Europe; HEALTH ECONOMICS
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-012062

ObjectiveTo compare healthcare costs in chronic kidney disease (CKD) stage 4 or 5 not on dialysis (estimated glomerular filtration rate <30 mL/min/1.73m2), peritoneal dialysis, haemodialysis and in transplanted patients with matched general population comparators.DesignPopulation-based cohort study.SettingSwedish national healthcare system.ParticipantsPrevalent adult patients with CKD 4 or 5 (n=1046, mean age 68 years), on peritoneal dialysis (n=101; 64 years), on haemodialysis (n=460; 65 years) and with renal transplants (n=825; 52 years) were identified in Stockholm County clinical quality registers for renal disease on 1 January 2010. 5 general population comparators from the same county were matched to each patient by age, sex and index year.Primary and secondary outcome measuresAnnual healthcare costs in 2009 incurred through inpatient and hospital-based outpatient care and dispensed prescription drugs ascertained from nationwide healthcare registers. Secondary outcomes were annual number of hospital days and outpatient care visits.ResultsPatients on haemodialysis had the highest mean annual cost (€87 600), which was 1.49 (95% CI 1.38 to 1.60) times that observed in peritoneal dialysis (€58 600). The mean annual cost was considerably lower in transplanted patients (€15 500) and in the CKD group (€9600). In patients on haemodialysis, outpatient care costs made up more than two-thirds (€62 500) of the total, while costs related to fluids ($29 900) was the largest cost component in patients on peritoneal dialysis (51%). Compared with their matched general population comparators, the mean annual cost (95% CI) in patients on haemodialysis, peritoneal dialysis, transplanted patients and patients with CKD was 45 (39 to 51), 29 (22 to 37), 11 (10 to 13) and 4.0 (3.6 to 4.5) times higher, respectively.ConclusionsThe mean annual costs were ∼50% higher in patients on haemodialysis than in those on peritoneal dialysis. Compared with the general population, costs were substantially elevated in all groups, from 4-fold in patients with CKD to 11, 29 and 45 times higher in transplanted patients and patients on peritoneal dialysis and haemodialysis, respectively.