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Abstract: TH-PO248

Economic Burden of Anemia-Related Transfusions in Medicare Dialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Li, Suying, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Matsuda, Tara, Amgen, Thousand Oaks, California, United States
  • Peng, Yi, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Belozeroff, Vasily, Amgen, Thousand Oaks, California, United States
  • Bhatt, Nisha, Amgen, Thousand Oaks, California, United States
  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
Background

Red blood cell transfusions are unwanted outcomes of poor anemia management, and remain important enough that Medicare has instituted a quality measure to ensure adequate care of dialysis patients. Previous studies investigated the burden of transfusions in Medicare dialysis patients, but did not investigate anemia-related transfusions (in the absence of another acute medical indication), or costs of inpatient transfusions due to anemia. We estimated Medicare spending for both inpatient and outpatient transfusions administered solely to manage anemia.

Methods

We used the USRDS dataset to analyze patients receiving dialysis in 2014. We included Medicare Parts A/B patients on dialysis at the beginning of 2014 and those initiating dialysis during 2014. Transfusions were identified using an algorithm requiring ICD-9 procedure and/or revenue center codes. We identified hospitalizations with 0- or 1-day stays with anemia as the principal diagnosis and no evidence of another reason for the hospitalization based on other diagnosis, procedure, and DRG codes. We identified outpatient, emergency department (ED), and observation (Obs) stays that appeared to be solely for transfusions. We calculated associated total Medicare paid costs by identifying costs directly associated with the transfusion and related costs for screening or monitoring in the pre- (day -3 to day -1) and post- (day 1 to day 3) period, and post-transfusion-related complications.

Results

We identified 9669 transfusions associated with anemia in the absence of other acute illness: 974 inpatient, 1264 ED/Obs, 7431 other outpatient. Total Medicare payments for these transfusions were $13.78 million: $7.37 million inpatient, $1.47 million ED/Obs, $4.95 million other outpatient. Inpatient transfusions accounted for 10% of total anemia-related transfusions, but for over 50% of total transfusion costs.

Conclusion

Costs related to anemia-induced transfusions are substantial. Savings can be potentially achieved by more closely following anemia treatment guidelines, and using outpatient settings in lieu of more expensive care settings.

Setting for TransfusionsNTransfusion CostsRelated CostsTotal CostsCosts per Transfusion
Inpatient974$7,362,817$4,271$7,367,088$7,564
ED/Obs1,264$1,451,228$15,392$1,466,620$1,160
Other outpatient7,431$4,741,086$206,339$4,947,425$666
Total9,669$13,555,131$226,002$13,781,133$1,425

Funding

  • Commercial Support