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Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis.

Liu J, Guo H, Gilbertson D, Foley R, Collins A - Ther Clin Risk Manag (2009)

Bottom Line: The study included 28,985 patients.Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost.The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA;

ABSTRACT
Most end-stage renal disease (ESRD) patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L) was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713) in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period.

No MeSH data available.


Related in: MedlinePlus

Graphical expression of assumed model. For simplicity and clarity, all baseline variables except persistent anemia appear together in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. The e1–e7 are residuals.
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f1-tcrm-5-319: Graphical expression of assumed model. For simplicity and clarity, all baseline variables except persistent anemia appear together in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. The e1–e7 are residuals.

Mentions: We hypothesized that the relationship between persistent anemia and total (all cause) medical cost was mediated by two factors: (1) anemia treatment and (2) general severity of illness. The anemia treatment factor was measured as EPO dose and number of blood transfusions in the follow-up period. The general severity of illness factor was measured by number of inpatient hospital days and number of vascular access procedures in the follow-up period. Mathematically, our assumed model is(1)Y=X1β1+X2β2+ ɛ(2)X1=X2γ+ ɛ1where Y is log(PPPM); X1 includes anemia treatment (the common factor of EPO dose and number of transfusions in the follow-up period) and general severity of illness (the common factor of hospitalization days and number of vascular access procedures in the follow-up period); X2 includes age, race, sex, ethnicity, number of hospital days in the entry period, comorbidity score and persistent anemia; ɛ and ɛ1 are residuals. A graphic expression of models (1) and (2) is displayed in Figure 1. For simplicity and clarity, all baseline variables except persistent anemia are grouped together, in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. To assess whether persistent anemia was associated with medical costs in ways other than those intermediated by anemia treatment and general severity of illness, persistent anemia was included in X2 in regression model (1), representing the total of the direct and other indirect associations, if any, between persistent anemia and medical costs, other than associations intermediated by anemia treatment and general severity of illness.


Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis.

Liu J, Guo H, Gilbertson D, Foley R, Collins A - Ther Clin Risk Manag (2009)

Graphical expression of assumed model. For simplicity and clarity, all baseline variables except persistent anemia appear together in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. The e1–e7 are residuals.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2690975&req=5

f1-tcrm-5-319: Graphical expression of assumed model. For simplicity and clarity, all baseline variables except persistent anemia appear together in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. The e1–e7 are residuals.
Mentions: We hypothesized that the relationship between persistent anemia and total (all cause) medical cost was mediated by two factors: (1) anemia treatment and (2) general severity of illness. The anemia treatment factor was measured as EPO dose and number of blood transfusions in the follow-up period. The general severity of illness factor was measured by number of inpatient hospital days and number of vascular access procedures in the follow-up period. Mathematically, our assumed model is(1)Y=X1β1+X2β2+ ɛ(2)X1=X2γ+ ɛ1where Y is log(PPPM); X1 includes anemia treatment (the common factor of EPO dose and number of transfusions in the follow-up period) and general severity of illness (the common factor of hospitalization days and number of vascular access procedures in the follow-up period); X2 includes age, race, sex, ethnicity, number of hospital days in the entry period, comorbidity score and persistent anemia; ɛ and ɛ1 are residuals. A graphic expression of models (1) and (2) is displayed in Figure 1. For simplicity and clarity, all baseline variables except persistent anemia are grouped together, in a box labeled “Baseline variables.” An arrow from one box to another, such as “Baseline variables” to “Medical costs,” means that the baseline variables were hypothesized to affect medical costs in the follow-up period. To assess whether persistent anemia was associated with medical costs in ways other than those intermediated by anemia treatment and general severity of illness, persistent anemia was included in X2 in regression model (1), representing the total of the direct and other indirect associations, if any, between persistent anemia and medical costs, other than associations intermediated by anemia treatment and general severity of illness.

Bottom Line: The study included 28,985 patients.Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost.The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA;

ABSTRACT
Most end-stage renal disease (ESRD) patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L) was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713) in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period.

No MeSH data available.


Related in: MedlinePlus