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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