title: Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: review of the literature.
abstract: OBJECTIVE
  To assess the health-related quality of life (HRQL) and economic burden of chronic kidney disease (CKD) related anemia in non-dialysis patients in the United States (US) via literature review.
  
  
  METHODS
  MEDLINE, EMBASE, PROQOLID, and Cochrane Library/Renal Group Resources were searched. Studies were appraised for patient populations, disease-specific versus generic HRQL assessments, and type and magnitude of health-related costs.
  
  
  RESULTS
  The treatment costs for CKD patients with anemia compared to those without anemia were significantly higher and were blunted but persistent after controlling for comorbidities and confounders. Intervention with erythropoiesis stimulating agents (ESA) decreased anemia and avoided hospital admissions. Costs were higher when anemia was poorly controlled or untreated. HRQL burden was mainly due to physical limitations and difficulty in ability to perform activities of daily living. Significant positive correlations between increases in hemoglobin levels and HRQL measures were reported.
  
  
  CONCLUSIONS
  Although evidence is limited, the economic and HRQL burden of non-dialysis CKD-related anemia is substantial. Under-treatment of anemia may contribute to higher resource consumption and higher costs; however, patient co-morbidities, use of erythropoietin-stimulating agents, and overall management introduce potential confounds. The contribution of anemia to humanistic disease burden is due to a constellation of factors, including physical activity and functional status.
authors.affiliation: Centre for Health Economics & Science Policy, United BioSource Corporation, 20 Bloomsbury Square, London, UK. Floortje.VanNooten@unitedbiosource.com
authors.forename: Floortje E
authors.initials: FE
authors.lastname: van Nooten
authors.forename: Julia
authors.initials: J
authors.lastname: Green
authors.forename: Ruth
authors.initials: R
authors.lastname: Brown
authors.forename: Fredric O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: Jay
authors.initials: J
authors.lastname: Wish
mesh_terms: D000740:Anemia / Q000191:economics* / Q000209:etiology* / Q000523:psychology; D003365:Costs and Cost Analysis; D006397:Hematinics / Q000191:economics; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000191:economics* / Q000523:psychology; D011788:Quality of Life; D014481:United States
chemical_list: D006397:Hematinics