Health Care Costs at Different DKD Stages

Type 2 diabetes (T2D) is a major contributing factor to kidney disease and the need for dialysis and kidney replacement therapy (KRT). Between 20% and 40% of patients with T2D develop diabetic kidney disease (DKD). The prevalence of DKD results in a significant economic burden. On average, T2D patients with commercial health insurance incur $24,209 in total costs annually after the onset of kidney disease. One recent analysis of commercial health care claims estimated the annual cost to payers in the United States was $7,725 per 4 months for stage 1 or 2 DKD patients and $11,879 for stage 5.  

The cost of DKD care also poses a burden to the Veterans Health Administration (VHA), the largest integrated health care system in the United States. Having a precise estimation of the costs incurred by DKD patients is an important step in finding ways to contain such costs. To fill this knowledge gap, Kibum Kim, BPharm, PhD, and fellow researchers conducted a retrospective cost-of-care study using data from the VHA. Their findings appeared in Kidney Medicine. 

The study focused on US veterans diagnosed with DKD between January 2016 and March 2022. Participants had T2D confirmed by either two or more health care encounters with T2D diagnosis within 365 days or records of noninsulin antidiabetic agent use along with one or more T2D diagnosis within 365 days.  

The study cohort comprised 685,288 patients with DKD, of whom 96.51% were male, 74.42% were White, and 93.54% were non-Hispanic. Study participants had at least one T2D encounter prior to the record of estimated glomerular filtration rate (eGFR) or microalbuminuria for DKD. The analytic cohort included patients with DKD, with either eGFR lower than 60 mL/min/1.73 m2 or microalbuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g), indicating kidney function decline and kidney damage. Stage G3a DKD comprised 50.16% of the cohort, while stage G3b comprised 25.03%. 

The researchers utilized a generalized linear model to calculate the cost of DKD care based on the stage, dialysis phase, and KRT needs of participants. The study outcome of interest was all-cause health care costs covered by VHA. Mean and median per-patient-per-month (PPPM) expenditures were estimated, and descriptive statistics were used to present the number of patients at different DKD stages after the analytic cohort entry and subsequent stage transition. Continuous variables, such as age, body mass index, and lab test values were summarized using means and standard deviations. 

Mean and median PPPM costs increased along with disease progression. The mean (SD) PPPM costs were $1,597 ($3,178) for stage 1; $1,772 ($4,269) for stage 2; $2,857 ($13,072) for stage 3a; $3,722 ($12,134) for stage 3b; $5,505 ($14,639) for stage 4; and $6,999 ($16,901) for stage 5. The average monthly cost for patients receiving regular dialysis was $12,299. Costs peaked at $38,359 during the first month of KRT but decreased to $6636 after a year. 

Limitations of the study include lack of a control group; a focus strictly on US veterans, which may have limited generalizability and led to underestimation of the total costs associated with DKD; and general limitations of any retrospective data analysis, such as selection bias and misclassification. 

In conclusion, the authors summarized, “Over a million patients across varying DKD stages were studied, revealing that the majority were in stage 3a. It was evident that certain health complications, including anemia, gout, and hypertension, became more prevalent in more advanced DKD stages. Furthermore, there was a significant racial disparity, with [Black patients] being more present in advanced DKD stages. Health care costs, correspondingly, increased monotonically with higher DKD stages. The findings of this study could provide valuable insights for health care providers, policymakers, and stakeholders in optimizing care and resource allocation for DKD patients.”  

Source: Kidney Medicine