title: Healthcare costs of the progression of chronic kidney disease and different dialysis techniques estimated through administrative database analysis.
abstract: BACKGROUND
  Chronic kidney disease (CKD) progression is associated with significant comorbidities and costs. In Italy, limited evidence of healthcare resource consumption and costs is available. We therefore aimed to investigate the direct healthcare costs in charge to the Lombardy Regional Health Service (RHS) for the treatment of CKD patients in the first year after starting hemodialysis and in the 2 years prior to dialysis.
  
  
  METHODS
  Citizens resident in the Lombardy Region (Italy) who initiated dialysis in the year 2011 (Jan 1 to Dec 31) were selected and data were extracted from Lombardy Regional databases on their direct healthcare costs in the first year after starting dialysis and in the 2 years prior to it was analyzed. Drugs, hospitalizations, diagnostic procedures and outpatient costs covered by RHS were estimated. Patients treated for acute kidney injury, or who died or stopped dialysis during the observational period were excluded.
  
  
  RESULTS
  From the regional population (>9,700,000 inhabitants), 1067 patients (34.3 % females) initiating dialysis were identified, of whom 82 % underwent only hemodialysis (HD), 13 % only peritoneal dialysis (PD) and the remaining 5 % both treatments. Direct healthcare costs/patient were € 5239, € 12,303 and € 38,821 (€ 40,132 for HD vs. € 30,444 for PD patients) for the periods 24-12 months pre-dialysis, 12-0 months pre-dialysis, and in the first year of dialysis, respectively.
  
  
  CONCLUSIONS
  This study highlights a significant economic burden related to CKD and an increase in direct healthcare costs associated with the start of dialysis, pointing to the importance of prevention programs and early diagnosis.
authors.affiliation: Health Economics, ProCure Solutions, Via Camozzi 1/c, 24027, Nembro, Bergamo, Italy. alessandro.roggeri@procuresolutions.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
authors.affiliation: Health Economics, ProCure Solutions, Via Camozzi 1/c, 24027, Nembro, Bergamo, Italy.
authors.forename: Daniela Paola
authors.initials: DP
authors.lastname: Roggeri
authors.affiliation: Regional Health Authority, Lombardy Region, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Zocchetti
authors.affiliation: Regional Health Authority, Lombardy Region, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bersani
authors.affiliation: Nephrology Unit, S. Uboldo Hospital, Cernusco sul Naviglio, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Conte
mesh_terms: D000067575:Administrative Claims, Healthcare; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine / Q000191:economics; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010530:Peritoneal Dialysis / Q000191:economics*; D017064:Process Assessment, Health Care / Q000191:economics*; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Administrative data; Chronic kidney disease; Cost; Dialysis