Managed Care Weekly Digest

Research on diabetes detailed by F. Laliberte and co-authors

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"To quantify from a health system perspective the incremental direct all-cause health care costs associated with a diagnosis of CKD in patients with diabetes and/or hypertension. An analysis was conducted of medical claims and laboratory data with dates of service between January 1, 2000, and February 28, 2006, from a managed care database for approximately 30 million members enrolled in 35 health plans. Each patient's observation period began on the date of the first diabetes or hypertension diagnosis (index date) and ended on the earlier of the health plan disenrollment date or February 28, 2006. Inclusion criteria were continuous insurance coverage in the 6 months prior to the index date and during the observation period, age at least 18 years, and at least 2 claims less than 90 days apart with a primary or secondary diagnosis for diabetes or hypertension. Exclusion criteria were cancer, lupus, or organ transplantation or chemotherapy at any time during the observation period. CKD was defined as at least 1 claim with a primary or secondary diagnosis for CKD and at least 2 glomerular filtration rate values of below 60 milliliters per minute per 1.73 square meters of body surface area (60 mL/min/1.73m(2)) at any time during the observation period. Bivariate and Tobit regression analyses were conducted to compare patients who developed CKD versus those who did not for annualized (per patient per month [PPPM) multiplied by 12) direct, all-cause, health care costs, defined as standardized net provider payments after subtraction of member cost-share. These costs consisted of outpatient services, inpatient services, and pharmacy claims. A subset analysis of the post-versus pre-CKD medical costs was also conducted for cohorts of patients with at least 60 days of observation before and after the development of CKD; that analysis measured both all-cause costs and costs for services directly related to CKD treatment (i.e., claims with a primary or secondary diagnosis of CKD or claims for dialysis services). 11,531 patients with diabetes, 74,759 patients with hypertension, and 4,779 patients with both conditions were identified, of whom 123 (1.1%), 1,137 (1.5%), and 712 (14.9%), respectively, developed CKD during the observation period. The CKD group was older than the no-CKD group in each cohort (mean ages for CKD vs. no-CKD were, respectively, diabetes only cohort: 60.7 vs. 49.9 years, P<0.001; hypertension only cohort: 63.6 vs. 53.6 years, P<0.001; diabetes and hypertension cohort: 63.4 vs. 61.8 years, P<0.001)," wrote F. Laliberte and colleagues.

The researchers concluded: "CKD was associated with significantly higher total direct all-cause health care costs, with unadjusted annualized per patient mean [median] cost diff."

Laliberte and colleagues published their study in the Journal of Managed Care Pharmacy (Direct All-Cause Health Care Costs Associated With Chronic Kidney Disease in Patients With Diabetes and Hypertension: A Managed Care Perspective. Journal of Managed Care Pharmacy, 2009;15(4):312-322).

Additional information can be obtained by contacting P. Lefebvre, Group Anal Ltee, 1080 Beaver Hall Hill, Suite 1810, Montreal, PQ H2Z 1S8, Canada.

The publisher of the Journal of Managed Care Pharmacy can be contacted at: Acad Managed Care Pharmacy, 100 N Pitt St., 400, Alexandria, VA 22314-3134, USA.

Keywords: Canada, Montreal, Cancer, Chemotherapy, Chronic Kidney Failure, Diabetes, Drug Therapy, Hypertension, Kidney Disease, Lupus, Managed Care, Nephrology, Oncology, Pharmaceuticals, Renal Disease, Transplantation.

This article was prepared by Managed Care Weekly Digest editors from staff and other reports. Copyright 2009, Managed Care Weekly Digest via NewsRx.com.