title: Healthcare costs in chronic kidney disease and renal replacement therapy: a population-based cohort study in Sweden.
abstract: To compare healthcare costs in chronic kidney disease (CKD) stage 4 or 5 not on dialysis (estimated glomerular filtration rate <30 mL/min/1.73m2), peritoneal dialysis, haemodialysis and in transplanted patients with matched general population comparators.
  
  
  
  Population-based cohort study.
  
  
  
  Swedish national healthcare system.
  
  
  
  Prevalent adult patients with CKD 4 or 5 (n=1046, mean age 68 years), on peritoneal dialysis (n=101; 64 years), on haemodialysis (n=460; 65 years) and with renal transplants (n=825; 52 years) were identified in Stockholm County clinical quality registers for renal disease on 1 January 2010. 5 general population comparators from the same county were matched to each patient by age, sex and index year.
  
  
  
  Annual healthcare costs in 2009 incurred through inpatient and hospital-based outpatient care and dispensed prescription drugs ascertained from nationwide healthcare registers. Secondary outcomes were annual number of hospital days and outpatient care visits.
  
  
  
  Patients on haemodialysis had the highest mean annual cost (€87 600), which was 1.49 (95% CI 1.38 to 1.60) times that observed in peritoneal dialysis (€58 600). The mean annual cost was considerably lower in transplanted patients (€15 500) and in the CKD group (€9600). In patients on haemodialysis, outpatient care costs made up more than two-thirds (€62 500) of the total, while costs related to fluids ($29 900) was the largest cost component in patients on peritoneal dialysis (51%). Compared with their matched general population comparators, the mean annual cost (95% CI) in patients on haemodialysis, peritoneal dialysis, transplanted patients and patients with CKD was 45 (39 to 51), 29 (22 to 37), 11 (10 to 13) and 4.0 (3.6 to 4.5) times higher, respectively.
  
  
  
  The mean annual costs were ∼50% higher in patients on haemodialysis than in those on peritoneal dialysis. Compared with the general population, costs were substantially elevated in all groups, from 4-fold in patients with CKD to 11, 29 and 45 times higher in transplanted patients and patients on peritoneal dialysis and haemodialysis, respectively.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas K
authors.initials: JK
authors.lastname: Eriksson
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.affiliation: Division of Nephrology, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.affiliation: Nephrology Unit, Department of Clinical Sciences, Intervention and Technology, Stockholm, Sweden.|Unit for Evidence Based Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
authors.affiliation: Unit of Renal Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Britta
authors.initials: B
authors.lastname: Hylander
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010530:Peritoneal Dialysis / Q000191:economics; D012042:Registries; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000628:therapy; D017582:Renal Replacement Therapy / Q000191:economics; D013548:Sweden
keywords: HEALTH ECONOMICS