Limits...
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

Flow chart for patient selection from the Centers for Medicare and Medicaid services end-stage renal disease database.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2690975&req=5

f2-tcrm-5-319: Flow chart for patient selection from the Centers for Medicare and Medicaid services end-stage renal disease database.

Mentions: The study cohort comprised 28,985 incident patients. Figure 2 illustrates in detail the study exclusion criteria by which patients were selected. Mean number of months with hemoglobin values below the target value of 110 g/L was 1.3 (Table 1). Persistent anemia groups were defined in three ways: number of months with hemoglobin values below 110 g/L (0, 1 to 2, or ≥3); whether the number of months with hemoglobin value below 110 g/L was ≤ or >1.3, the cohort mean; and whether mean hemoglobin over the entry period was < or ≥110 g/L. Younger age, female sex, African American race, Hispanic ethnicity, hospitalization during the entry period, and each comorbid condition studied were associated with persistent anemia. In the six-month follow-up period, mean follow-up time was 5.63 months per patient, and average medical cost was $6267 per patient per month in the follow-up period.


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)

Flow chart for patient selection from the Centers for Medicare and Medicaid services end-stage renal disease database.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2690975&req=5

f2-tcrm-5-319: Flow chart for patient selection from the Centers for Medicare and Medicaid services end-stage renal disease database.
Mentions: The study cohort comprised 28,985 incident patients. Figure 2 illustrates in detail the study exclusion criteria by which patients were selected. Mean number of months with hemoglobin values below the target value of 110 g/L was 1.3 (Table 1). Persistent anemia groups were defined in three ways: number of months with hemoglobin values below 110 g/L (0, 1 to 2, or ≥3); whether the number of months with hemoglobin value below 110 g/L was ≤ or >1.3, the cohort mean; and whether mean hemoglobin over the entry period was < or ≥110 g/L. Younger age, female sex, African American race, Hispanic ethnicity, hospitalization during the entry period, and each comorbid condition studied were associated with persistent anemia. In the six-month follow-up period, mean follow-up time was 5.63 months per patient, and average medical cost was $6267 per patient per month in the follow-up period.

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