Health care resource utilization and the impact of anemia management in patients with chronic kidney disease.
BACKGROUND
Limited information exists on resource utilization patterns and overall patient management of chronic kidney disease (CKD) before the initiation of dialysis therapy.


METHODS
A retrospective claims analysis from January 1997 to December 1999 was conducted using a managed care database on 1,936 incident dialysis patients, examining the 12 months preceding dialysis initiation to evaluate whether managed care patients with CKD are receiving expected interventions and appropriate management of CKD.


RESULTS
Mean age was 66.8 years, 46% were women, 91.2% had claims for facility services, 97.6% had claims for professional services, and 95.7% had claims for outpatient pharmacy, with mean costs per patient of $26,204, $9,623, and $1,503, respectively. Sixty-two percent of patients were hospitalized, averaging 1.3 admissions annually ($14,818/admission; average, 7.8 d/admission). Despite high overall resource use, treatments for preparation for dialysis therapy, appropriate tests, and nutritional supplements (eg, phosphate binders, B-complex combinations, and vitamins with iron) were administered infrequently. Comorbid conditions, such as anemia (47.4%) and diabetes (53%), were appropriately addressed with erythropoietin (10.5%) and angiotensin-converting enzyme inhibitors (38%) in only a minority of cases. In preparation for dialysis therapy, only 20.8% underwent a vascular access procedure.


CONCLUSIONS
Although patients consumed significant amounts of resources during the 12 months before dialysis initiation, many were not using expected resources for the appropriate management of CKD. A number of opportunities exist to improve predialysis care through better management of these conditions.
Oxford Health Plans, White Plains, NY 10601, USA. RLOndon@oxhp.com
Roger
R
London
Amy
A
Solis
George A
GA
Goldberg
Sally
S
Wade
Seonyoung
S
Ryu
D000368:Aged; D000740:Anemia / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000191:economics / Q000706:statistics & numerical data; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D019587:Dietary Supplements / Q000191:economics / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States