Abstract: TH-PO847
Economic Impact of Dementia After Kidney Transplantation: A Matched Cohort Analysis
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
- Axelrod, David, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Xiao, Huiling, Saint Louis University, Saint Louis, Missouri, United States
- McAdams-DeMarco, Mara, New York University, New York, New York, United States
- Chen, Yusi, New York University, New York, New York, United States
- Bae, Sunjae, New York University, New York, New York, United States
- Caliskan, Yasar, Saint Louis University, Saint Louis, Missouri, United States
- Segev, Dorry L., New York University, New York, New York, United States
- Schnitzler, Mark, Saint Louis University, Saint Louis, Missouri, United States
Background
Dementia risk is increased among patients with kidney disease, including kidney transplant (KTx) recipients, and is assocaited with adverse outcomes. To date, the cost implications of dementia after KTx are not well described.
Methods
We examined USRDS data (2006–2016) to compare costs incurred in the care of Medicare-insured KTx recipients with diagnosed dementia vs. matched controls, based on payments on Medicare claims. KTx recipients age 65+ years with post-KTx dementia were identified by diagnosis codes and matched to recipients without dementia, based on propensity score for dementia using recipient (demographic and clinical), donor, and transplant factors. Average costs per month, marginal costs per month, and cumulative costs were compared after the dementia diagnosis vs after equivalent time post-KTx in the controls.
Results
We identified 1,556 KTx recipients with dementia after KTx (mean time to diagnosis: 4.2±2.8) and 3,112 controls. Cases and controls were well balanced with regard to baseline factors, including mean age (70.3±4.2 vs 70.1±4.0 yrs.), sex (37.7% vs. 35.8% women), race (26.0% vs. 25.5% African American), and cause of ESKD (46.2% vs. 46.3% diabetes). Monthly costs approaching a dementia diagnosis rose to peak of ~$9,229, and exceeded that of cases over 36 mos. of follow-up (Fig. A). The marginal cost impact of dementia diagnosis ranged from $6,215 to $945 (Fig. B). At 36-mo. post dementia diagnosis, dementia patients incurred $34,034 (95% CI $12,192–$60,816) more costs than those without dementia. Higher spending occurred despite substantially lower survival in patients with dementia vs. matched controls.
Conclusion
KTx recipients with dementia incur higher costs of care and experience lower survival compared to matched controls. Further research is needed to develop care pathways to optimize clinical and economic outcomes of KTx recipients with dementia.
Funding
- NIDDK Support