Management of cardiovascular disease in chronic kidney disease: implications for managed care.
Despite the rising incidence of chronic kidney disease (CKD), this condition remains underrecognized and is costly to treat. Care of CKD accounts for a substantial portion of US Medicare spending, with major costs primarily associated with hospitalization and drug therapy. The leading cause of death and hospitalization in patients with CKD is cardiovascular disease (CVD). Strategies to improve identification of CKD have proved to be cost-effective in the highest risk patients (eg, those with diabetes), but determining the most appropriate way to identify high-risk patients remains a significant challenge. There is also evidence to suggest that referral to a specialist once the estimated glomerular filtration rate reaches approximately 60 mL/min/1.73 m2 is cost-effective, especially when patients are greater than 50 years of age and/or have diabetes. Individualized patient care has shown to be cost-effective (or even cost saving), and associated with improved outcomes, such as reduced incidence of CVD events and mortality. Individualized care centers treat numerous comorbidities (eg, hypertension, diabetes, albuminuria, dyslipidemia) in a given patient to prevent the downstream consequences of worsening CVD. Ensuring access to specialist care and effective therapies, along with adherence to such therapies, appears to be a cost-effective, or even cost-saving, strategy based on current available evidence.
Northeastern University Bouvé College of Pharmacy and Allied Health Sciences, Boston, MA, USA. david_calabrese@medmetricshp.com
David
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Calabrese
D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008329:Managed Care Programs; D008875:Middle Aged; D014481:United States / Q000453:epidemiology