Abstract
Background and Aims
Recent studies have shown an association between Sodium Glucose Co-Transporter 2 inhibitor (SGLT-2i) class of drugs and lower healthcare costs compared with other glucose lowering therapy, in type 2 diabetes (T2D) patients mainly as a result of reduced rates of cardiovascular and other T2D-associated outcomes. The DAPA-CKD Trial (A study to evaluate the effect of dapagliflozin on renal outcomes and CV mortality in patients with CKD) is the first SGLT-2i renal outcomes trial to test the efficacy and safety of an SGLT-2i, dapagliflozin, in patients with CKD with and without T2D. The objective of this study is to assess the healthcare resource utilization and cost in a “DAPA-CKD-like population” (eGFR 25-75ml/min/1.73m2 and UACR 200-5000mg/g) using a contemporary US healthcare system.
Method
Data from the Henry Ford Health System (HFHS) were used to identify persons with CKD stages 2 through 4 between 2006 and 2016 (based on eGFR labs) and patients were followed through 2018. Persons with no confirmatory eGFR > 90 days from index date, death within 30 days, history of renal transplant, and evidence of renal replacement therapy, or progression to CKD stage 5 during the baseline period (6 months pre or post index date) were excluded.
Inpatient admissions, inpatient days, emergency department encounters, and ambulatory care encounters with primary care, specialty care and overall were assessed. Cumulative utilization was evaluated for all patients and evaluation based on the follow-up time. Patients were censored on date of death, last contact with the Health System or at December 31st, 2018. The utilization rates are the total observed utilization divided by follow-up time and reported as an annual rate. Billing records for all care with HFHS were used to estimate costs.
Results
6,557 patients (mean age 62.9 years, 46.2% male) met the eligibility criteria and are included in the study cohort. The population was stratified by UACR (0-<30, 30–199, 200–5,000mg/g). The DAPA-CKD-like population (200-5000mg/g) was associated with significantly higher annualized per-patient healthcare costs, $39,222/yr (UACR 200-5000mg/g) vs. $19,547/yr (UACR <30mg/g). This increased healthcare utilization was predominantly driven by increased acute care, including hospital admissions, inpatient days and emergency department visits. Persons in the highest UACR category were almost three times more likely to have a hospital admission compared to the lowest UACR (rates 0.55/year vs. 0.20/year, respectively; see Figure below). Persons in the lowest UACR category had more primary care visits per year compared with those with highest UACR (5.81 vs 5.21). In contrast, the highest number of outpatient specialist visits per year was reported for the DAPA-CKD-like population (7.55 vs. 6.74).
Conclusion
This analysis of a contemporary US healthcare system demonstrated that there exists a high disease burden in the DAPA-CKD-like population as seen by the substantial increase in healthcare resource utilization and costs compared to other cohorts of patients with a lower UACR. These results highlight the need for innovative therapies to improve patient outcomes in this population.
The Last Year Before Graft Failure Negatively Impacts Economic Outcomes and is Associated With Greater Healthcare Resource Utilization Compared With Previous Years in the United Kingdom
