SP301THE ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE: FINDINGS FROM A SYSTEMATIC LITERATURE REVIEW

Abstract

INTRODUCTIONANDAIMS: To use published research to assess the costs and resource use associated with chronic kidney disease (CKD), including end-stage renal disease (ESRD), by comparing costs against individualswithout CKDand by CKDstage. METHODS: Electronic databases (Embase, MEDLINE and the Cochrane Library) were searched in May 2017 using terms for CKD, ESRD, costs and resource utilization. Only studies published in 2012-2017 reporting costs for a population of 100 patients or more were included in the final review. RESULTS: Of the 47 relevant papers identified, nine reported data that were relevant for the purposes of this review: three studies reported costs/resource use for CKD relative to individuals without CKD, five studies reported costs by CKD stage, and one study reported data for both types of comparison. Two studies showed that the proportion of patients who experienced hospitalization was 53%-209% higher in patients with pre-dialysis CKD and 230%-698% higher in those with ESRD than in patients with normal kidney function. In addition, hospital stays were significantly longer for patients with CKD or ESRD. In a population experiencing hospitalization and surgical intervention for hip fracture, the total costs arising from this were 11% and 34% higher for patients with CKD and ESRD respectively, compared with costs for patients without CKD. Total healthcare costs in a patient population with hepatitis C were reported to be significantly higher (185%) for patients with CKD or ESRD compared with those who did not have CKD. Another study showed that direct healthcare costs were 49% higher for patients with CKD stage 1-2 than for patients without CKD and increased with disease severity to 91% higher for patients with CKD stage 3 and 695% higher for patients with CKD stage 4-5 (both compared with no CKD). Three studies showed that CKD stage 3 was associated with 9%-50% higher medical costs than CKD stages 1-2, and one study reported that patients with CKD stage 3 incurred 77% higher costs than those with CKD stage 0-2 whose disease did not progress to stage 3. Costs increased with each successive CKD stage thereafter. Five studies reported cost increases (33%-317%) for stages 4-5 (either pre-dialysis CKD or CKD with requirement for renal replacement therapy) compared with stage 3. Compared with stage 4, healthcare costs increased by 31%-71%for CKD stage 5 (with or without requirement for dialysis) in two studies. In an additional study, progression of CKD stage 4 to ESRD was associated with 77% higher costs than CKD stage 4 without progression. CONCLUSIONS: The evidence identified in this comprehensive systematic literature review has shown that CKD is associated with a significant economic burden, which increases progressively from CKD stages 1-2 to ESRD. Delay or prevention of progression might result in considerable cost savings.