What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease?
BACKGROUND
Reliable estimates of the impacts of chronic kidney disease (CKD) stage, with and without cardiovascular disease, on hospital costs are needed to inform health policy.


METHODS
The Study of Heart and Renal Protection (SHARP) randomized trial prospectively collected information on kidney disease progression, serious adverse events and hospital care use in a cohort of patients with moderate-to-severe CKD. In a secondary analysis of SHARP data, the impact of participants' CKD stage, non-fatal cardiovascular events and deaths on annual hospital costs (i.e. all hospital admissions, routine dialysis treatments and recorded outpatient/day-case attendances in United Kingdom 2011 prices) were estimated using linear regression.


RESULTS
7,246 SHARP patients (2,498 on dialysis at baseline) from Europe, North America, and Australasia contributed 28,261 years of data. CKD patients without diabetes or vascular disease incurred annual hospital care costs ranging from £403 (95% confidence interval: 345-462) in CKD stages 1-3B to £525 (449-602) in CKD stage 5 (not on dialysis). Patients in receipt of maintenance dialysis incurred annual hospital costs of £18,986 (18,620-19,352) in the year of initiation and £23,326 (23,231-23,421) annually thereafter. Patients with a functioning kidney transplant incurred £24,602 (24,027-25,178) in hospital care costs in the year of transplantation and £1,148 (978-1,318) annually thereafter. Non-fatal major vascular events increased annual costs in the year of the event by £6,133 (5,608-6,658) for patients on dialysis and by £4,350 (3,819-4,880) for patients not on dialysis, and were associated with increased costs, though to a lesser extent, in subsequent years.


CONCLUSIONS
Renal replacement therapy and major vascular events are the main contributors to the high hospital care costs in moderate-to-severe CKD. These estimates of hospital costs can be used to inform health policy in moderate-to-severe CKD.
Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. seamus.kent@dph.ox.ac.uk.
Seamus
S
Kent
Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. iryna.schlackow@dph.ox.ac.uk.
Iryna
I
Schlackow
Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. jlk@biomedepi.com.
Jingky
J
Lozano-Kühne
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. christina.reith@ctsu.ox.ac.uk.
Christina
C
Reith
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. jonathan.emberson@ctsu.ox.ac.uk.
Jonathan
J
Emberson
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. richard.haynes@ctsu.ox.ac.uk.
Richard
R
Haynes
Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. alastair.gray@dph.ox.ac.uk.
Alastair
A
Gray
Menzies School of Health Research, Sydney, Australia. Alan.Cass@menzies.edu.au.
Alan
A
Cass
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. colin.baigent@ctsu.ox.ac.uk.
Colin
C
Baigent
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. martin.landray@ctsu.ox.ac.uk.
Martin J
MJ
Landray
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. will.herrington@ctsu.ox.ac.uk.
William
W
Herrington
Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. boby.mihaylova@dph.ox.ac.uk.
Borislava
B
Mihaylova
D000368:Aged; D044362:Australasia; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics* / Q000628:therapy; D018450:Disease Progression; D005060:Europe; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000191:economics* / Q000628:therapy; D012720:Severity of Illness Index