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Kidney Week

Abstract: PO2402

Well-Managed CKD and Its Association with Healthcare Resource Utilization and Costs

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Li, Yong, Humana Healthcare Research, Louisville, Kentucky, United States
  • Barve, Kanchan, Humana Inc, Louisville, Kentucky, United States
  • Cockrell, Meghan Martin, Humana Inc, Louisville, Kentucky, United States
  • Agarwal, Amal, Humana Inc, Louisville, Kentucky, United States
  • Casebeer, Adrianne W., Humana Inc, Louisville, Kentucky, United States
  • Poonawalla, Insiya B., Humana Healthcare Research, Louisville, Kentucky, United States
Background

Diabetes and hypertension are prevalent in CKD. The association of coordinated care with outcomes in the setting of these coexisting comorbidities is not well understood. This study evaluated the association between well-managed care and healthcare resource utilization (HCRU) and costs.

Methods

Using the Humana Research Database, this retrospective cohort study identified 241,628 patients with CKD Stage > 3a (3% diabetes, 40% hypertension, 50% diabetes and hypertension, 7% neither diabetes nor hypertension) in 2017. Eligible patients were indexed on first evidence of CKD and required to be enrolled in a Medicare Advantage Prescription Drug plan for > 12 months pre- and post-index date. Patients who had kidney transplant or hospice election pre-index were excluded. Well-managed care measures included hemoglobin A1c (HbA1c) monitoring, adherence to glucose medications, cardiovascular (CV) therapy, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), and routine primary care provider (PCP)/nephrologist visits. HCRU and costs were evaluated within 12-months post-index.

Results

The cohort was 55% female, 77% White, average age of 75 years, and comprised of 67%, 23%, 10%, and 1% patients with Stages 3a, 3b, 4 and 5 CKD, respectively. Patients with diabetes and hypertension who were adherent to well-managed care were significantly less likely to experience an inpatient (IP) admission or emergency department (ED) visit (Table 1) and incurred lower mean monthly costs compared with patients who were not adherent to well-managed care. Similar results were observed for patients with diabetes only, hypertension only, or neither condition.

Conclusion

Well-managed diabetes and/or hypertension in patients with CKD was associated with lower HCRU and costs. Findings may inform innovative models of CKD care coordination.

Measures of well-managed care*
 Odds ratio [95% Confidence Interval]
Outcomes> 2 HbA1c lab values < 60 days not covered, glucose therapy< 60 days not covered, CV therapy> 3 yearly nephrology visits> 2 yearly PCP visits
IP admission0.60 [0.58-0.62] 0.90 [0.87-0.92]0.93 [0.90-0.96]0.74 [0.68-0.80]0.90 [0.87-0.94]
ED visit0.70 [0.68-0.73]0.89 [0.87-0.91]0.96 [0.93-0.99]0.84 [0.78-0.91]0.93 [0.90-0.97]

* ACEi/ARBs not significant