The following is a summary of “Costs Associated With Progression of Mildly Reduced Kidney Function Among Medicare Advantage Enrollees,” published in the June 2023 issue of Kidney Medicine by Diamantidis et al.
In the past two decades, early chronic kidney disease (CKD) prevalence in elderly adults has increased, but disease progression is variable. It is unknown whether the cost of health care varies by progression trajectory. This study aimed to estimate the trajectories of CKD progression and investigate the Medicare Advantage (MA) healthcare costs of each trajectory over three years for a large cohort of MA enrollees with mildly reduced kidney function. The design of the investigation was a Cohort investigation. In 2014-2017, the setting and population included 421,187 MA enrollees with stage G2 CKD.
Researchers identified five distinct kidney function trajectories over time. From a payer’s perspective, each trajectory’s mean total healthcare costs were described in each of the three years listed below: 1 year before and 2 years after the index date establishing stage G2 CKD (study entry). At the study entry, the mean estimated glomerular filtration rate (eGFR) was 75.9 mL/min/1.73 m2, and the median (interquartile range) follow-up period was 2.6 (1.6, 3.7) years. The average age of the cohort was 72,6 years, and most of its members were female (57.2%) and White (71.2%). They identified 5 distinct kidney function trajectories: stable eGFR (22.3%), slow eGFR decline with a mean eGFR at study entrance of 78.6 (30.2%), slow eGFR decline with an eGFR at study entry of 70.9 (28.4%), steep eGFR decline (16.3%), and accelerated eGFR decline (2.8%).
The mean costs of enrollees with accelerated eGFR decline were double those of enrollees in each of the other four trajectories yearly ($27,738 versus $13,498 for an eGFR that remained stable one year after study admission). Results may not be generalizable outside of MA and without albumin values. Few MA enrollees with accelerated eGFR decline incur disproportionately higher costs than those with marginally diminished kidney function.