Cost and Healthcare Resource Use in Patients with Anemia in CKD Using Linked US Claims and Electronic Health Records

Background: Anemia is a routinely occurring complication in patients with chronic kidney disease (CKD), but current data regarding its economic impact are lacking. This study described direct costs and healthcare resource utilization in non-dialysis CKD patients with and without baseline anemia in real-world practice.

Methods: This retrospective analysis of the integrated Limited Claims and Electronic Health Record (IBM Health, Armonk, NY) spanned Jan 1, 2012 to Sep 30, 2018. Patients were aged ≥18 years with ≥2 estimated glomerular filtration rate (eGFR) measures <60 mL/min/1.73 m² ≥90 days apart. Anemia was defined as any hemoglobin (Hb) value <10 g/dL observed within 6 months of confirmatory eGFR (baseline period). Total and site-specific costs and selected healthcare resource utilization were analyzed and stratified by presence of baseline anemia, Hb range, CKD stage, sex, and insurance type.

Results: Of 22,720 patients, 23% (n=5283) had baseline anemia, 77% (17,437) did not; females accounted for 60% and 56% of the patients, mean ages (± SD) were 70 (14) and 70 (12) years, and median follow-up times were 2.9 and 3.8 years, respectively. Baseline anemia prevalence by CKD stage was 18% (stage 3a), 25% (3b), 41% (4), and 73% (5). Median per patient total costs were $49012 and $31667, total hospitalization costs were $33479 and $22695, and total ER costs were $2232 and $1891, respectively. Median annual number of transfusions doubled (2 vs 1) and annual transfusion cost was 50% greater in patients with vs without baseline anemia, respectively. Slightly increased costs were associated with male sex and were markedly increased by advancing CKD stage (>3a), baseline Hb <10, and supplemental Medicare and non-capitated insurance coverage.

Conclusion: Anemia is associated with substantially added direct cost and healthcare resource utilization experienced by patients with non-dialysis CKD, in both early and advanced stages and with lower Hb. Effective management of anemia in CKD offers an opportunity to address this ongoing burden.