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Abstract: TH-PO273

Marginal Cost of Frailty Among Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Sy, John, Long Beach VA Medical Center, Long Beach, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States

Patients on dialysis incur disproportionately high costs compared to other Medicare beneficiaries, and frail individuals may cost more. We examined the extent to which frailty contributes to higher costs among dialysis patients.


The ACTIVE/ADIPOSE study enrolled adult hemodialysis patients from June 2009 to August 2011. Individuals utilizing Medicare as the primary payer with active claims were selected for inclusion. Frailty was assessed at baseline and annually for 2 years using Fried’s frailty phenotype. Baseline demographic data and costs were derived from linkage with the USRDS and Medicare claims (Part A, B, and D) standard analysis files. We used generalized estimating equations incorporating time-updated frailty to estimate the marginal cost of being frail at the beginning of each year of follow-up, adjusting for age, gender, body mass index (BMI), and comorbid conditions (diabetes, coronary artery disease, and congestive heart failure). All costs were adjusted for inflation to 2017 US dollars and reported per patient per year (pppy).


Among 771 individuals enrolled in the ACTIVE/ADIPOSE study, 345 met inclusion criteria with an average age of 56.1 years and BMI of 29 kg/m2. 28% of patients were considered frail at baseline, whereas 54% were frail at any time point. Over mean 2.3 years of follow up, frail individuals incurred 23% (95% CI 10-37%) higher costs compared with non-frail individuals ($101,000 pppy, 95% CI $89,000-$116,000, vs $83,000 pppy, 95% CI $75,000 – $91,000). The difference in costs between frail and non-frail patients appears to be driven primarily by higher hospitalization expenditures (26% higher, 95% CI 11%-43%). Neither physician/supplier costs (12% higher, 95% CI 2% lower to 29% higher) nor were expenditures for pharmacy benefits (2% higher, 95% CI 8% lower to 13% higher) statistically different between frail and non-frail individuals.


Frail dialysis patients incur a significantly higher cost relative their non-frail counterparts, primarily driven by higher hospitalization costs. Efforts to address frailty and its association with hospitalizations may lead to a significant reduction in health care expenditure among dialysis patients.


  • NIDDK Support