Non-Dialysis CKD Patients Have High Out-of-Pocket Expenses

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Chronic kidney disease patients spent $760 more out of pocket for health care than  patients free of CKD, stroke, or cancer.
Chronic kidney disease patients spent $760 more out of pocket for health care than patients free of CKD, stroke, or cancer.

Non-dialysis dependent chronic kidney disease (NDD-CKD) patients are burdened by higher total medical, dental, and vision expenses than even cancer and stroke patients, and they spend more out of pocket, a new study finds.

Total health care expenditures, including amounts covered by insurance, cost NDD-CKD patients a median $12,877 annually compared with $8150 for stroke patients, $7428 for cancer patients, and $1189 for other patients. 

Out-of-pocket expenditures cost NDD-CKD patients a median of $1439 per year compared with $770 for cancer (colon, breast, or lung) patients, $748 for stroke patients, and $226 for patients without the 3 chronic conditions. Previous studies had found NDD-CKD, cancer, and stroke to be the 3 costliest conditions for Medicare beneficiaries. While dialysis patients are known to incur high health care costs, research has shown that expenditures rise for CKD patients before dialysis initiation. Out-of-pocket payments include deductibles, coinsurance, copayments, and other uncovered expenses for health care services and supplies.

NDD-CKD patients spent 7.2% of their household income in out-of-pocket costs, while stroke patients spent 5.8%, cancer patients 5.1%, and patients without these conditions 1.9%. The national data were obtained from the Agency for Healthcare Research and Quality's (AHRQ) Medical Expenditure Panel Survey 2011-2013 and  then weighted based on information from 52 NDD-CKD patients, 870 cancer patients, 1104 stroke patients, and 72,241 patients free of the 3 conditions. Average patient age was similar for NDD-CKD, cancer, and stroke (65.5, 66.1, and 68.2 years, respectively) but older than patients without the conditions (47.8 years).

"Higher out-of-pocket cost burden can impede efforts to prevent disease progression," Talar W. Markossian, PhD, MPH, and colleagues wrote in BMC Nephrology. "Previous research has shown that some patients opt to not fill prescriptions or take less than the prescribed amount due to out-of-pocket costs."

NDD-CKD patients tend to have multiple comorbidities, the researchers noted. According to the survey results from patients and providers, 87.8%  also had high blood pressure, 85% had high cholesterol, 63.7% had arthritis, 49.6% had diabetes, and 41.5% had heart diseases other than CAD, to name the top 5. CKD patients average 10.8 doctor visits per year and more than 60% with stage 3 CKD take 5 or more medications daily, according to other research cited by the investigators.

"The high total number of physician visits and medications required for chronic kidney disease care drives up total direct healthcare expenditures and likely also increases out-of-pocket expenditures, creating a financial burden for patients," Markossian and colleagues suggested.

References

1. Small C, Kramer HJ, Griffin KA, Vellanki K, Leehey DJ, Bansal VK, and Markossian TW. Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures. BMC Neph. (2017) 18:3. DOI 10.1186/s12882-016-0432-2

2. Kidney disease patients have higher out-of-pocket costs than stroke and cancer patients. January 17, 2017. Loyola University Health System. [press release]

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