title: Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures.
abstract: BACKGROUND
  Previous studies have documented the high costs of non-dialysis dependent chronic kidney disease (CKD) but out-of-pocket healthcare expenditures remain poorly explored. This study described total direct and out-of-pocket expenditures for adults with non-dialysis dependent CKD and compared expenditures with those for cancer or stroke.
  
  
  METHODS
  This study used data from the 2011-2013 Medical Expenditure Panel Survey, a national survey of healthcare expenditures in the U.S.
  
  
  METHODS
  Expenditures were determined for adults with the following chronic diseases: CKD defined by 585 ICD9 codes (n = 52), cancer (colon, breast or bronchus/lung) (n = 870), or stroke (n = 1104). These represent adults who were aware of their conditions or visited a healthcare provider for the condition during the study period. Generalized linear models were used to estimate the marginal effects of CKD, cancer or stroke on adjusted expenditures compared to adults without CKD, cancer or stroke (n = 72,241) while controlling for demographics and co-morbidities and incorporating the sample weights of the complex survey design.
  
  
  RESULTS
  The mean age for group with CKD, cancer or stroke was 65.5, 66.1, and 68.2 years, respectively, while mean age for group without CKD, cancer or stroke was 47.8 years. Median values of total direct and out of pocket healthcare expenditures ranged from as high as $12,877 (Interquartile Range [IQR] $5031-$19,710) and $1439 ($688-$2732), respectively, with CKD, to as low as $1189 (IQR $196-$4388) and $226 (IQR $20-$764) in the group without CKD, cancer or stroke. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158-679) or stroke ($246; 95% CI 87-406) relative to group without CKD, cancer or stroke.
  
  
  CONCLUSIONS
  Total and out of pocket health expenditures for adults with non-dialysis dependent CKD are high and may be equal to or higher than expenditures incurred by adults with cancer or stroke.
authors.affiliation: Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Small
authors.affiliation: Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA.|Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.|Hines Veterans Affairs Medical Center, Hines, IL, USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Kramer
authors.affiliation: Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.|Hines Veterans Affairs Medical Center, Hines, IL, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Griffin
authors.affiliation: Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.|Hines Veterans Affairs Medical Center, Hines, IL, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Vellanki
authors.affiliation: Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.|Hines Veterans Affairs Medical Center, Hines, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Leehey
authors.affiliation: Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bansal
authors.affiliation: Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA. tmarkossian@luc.edu.
authors.forename: Talar W
authors.identifier: http://orcid.org/0000-0002-8147-7083
authors.initials: TW
authors.lastname: Markossian
mesh_terms: D000368:Aged; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D020521:Stroke / Q000191:economics* / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology