Suehs B, Davis J, Xu Y, Bunniran S, Schilling C, Patel S, Vuong K, Perkins R. Prevalence of severe anemia and total healthcare costs in chronic kidney disease in Medicare Advantage Prescription Drug (MAPD) patients. Poster presented at the Virtual AMCP Nexus 2020; October 2020. [abstract] J Manag Care Spec Pharm. 2020 Oct; 26(10-a):S70.

OBJECTIVE: 1) To examine prevalence of severe anemia among nondialysis dependent (NDD) patients with CKD Stage 3-5; 2) To describe total healthcare costs (THCC) for CKD patients with severe anemia.

METHODS: Using Humana claims data (medical, pharmacy, lab), two study designs were used for this descriptive analysis: 1) A crosssectional study of data within calendar year (CY) 2018 to examine prevalence of severe anemia; and 2) A retrospective cohort study to examine costs for patients with severe anemia. Anemia prevalence was determined using lab results Hb< 10 within the CY. For the cost analysis, the index date was the date of first lab value indicating severe anemia (Hb<10) after CKD diagnosis. Patients were classified based on CKD stage in the 12 months pre-index. THCC (medical+pharmacy) were examined in the 12 months post-index. Costs included plan and member share.

RESULTS: In patients with NDD CKD, severe anemia prevalence increased as CKD stage increased. Prevalence rates were 8%, 25%, and 51% in stage 3, 4, and 5, respectively. The mean number of Hb lab tests/year increased as stage increased (6, 8, 10). In patients with CKD and severe anemia, median THCC increased as CKD progressed ($19,902, $25,300 and $36,589 in stage 3, 4, and 5, respectively), driven by an increase in medical costs (median: $14,640, $19,269, and $30,270). Pharmacy costs remained consistent across CKD stages (median: $2,243, $3,058, $2,766). A similar trend was seen in the mean THCC by CKD stage ($36,768, $41,629, $53,459) mostly driven by medical costs (mean: $29,536, $34,068, $46,853). Mean pharmacy costs were $7,232, $7,561, $6,606.

CONCLUSIONS: Prevalence of severe anemia in the MAPD NDD CKD patients increased by CKD stage; half of patients in Stage 5 with severe anemia. Availability of lab data resulted in a more precise clinical definition for severe anemia. After anemia diagnosis, THCC increased as CKD stage progressed, which was mainly driven by medical costs.

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