The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease

https://doi.org/10.1016/j.semnephrol.2016.05.008Get rights and content

Summary

The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are substantial and increase throughout disease progression. There is significant variability in the evidence about direct and indirect costs attributable to CKD and end-stage renal disease, with the most complete evidence concentrated on direct health care costs of patients with advanced to end-stage CKD. There are substantial gaps in evidence that need to be filled to inform clinical practice and policy.

Section snippets

Principles of Measuring the Economic Burden of CKD

Economic evaluation of health conditions principally considers two types of costs: direct and indirect. Direct costs reflect the value of all goods, services, and other resources consumed in the provision of interventions or in dealing with the side effects as well as the current and downstream consequences of disease.1 From a societal (or social) perspective, this refers to time and financial costs incurred by patients, their caregivers, employers, and payers (private and public). Direct costs

Challenges in Estimating the Economic Burden of Kidney Disease

In principle, the factors influencing the direct and indirect costs of kidney disease include the incidence and prevalence of disease, the use of costly therapeutic modalities and care management strategies, CKD-attributable morbidity (eg, existing comorbid conditions, new conditions arising from CKD-associated complications, and hospitalization) and disability, and premature death. Variation in the evidence base about these influencing factors presents several challenges to the precise

Reviewing the Evidence on the Economic Burden of CKD, by Stage

Evidence on the key factors driving the economic burden of CKD varies by CKD stage. Across the stages of CKD, understanding the key factors driving direct and indirect costs can identify priorities for research that are needed to inform future clinical and policy interventions.

Discussion

The societal economic burden of CKD over the span of the disease continuum is substantial (Fig. 2), although the variability in the evidence about direct and (especially) indirect costs make it difficult to generate a precise estimate overall or by stage. Direct and indirect costs increase throughout disease progression, with a preponderance of measured costs occurring among patients with stage 3 CKD and with stages 4 and 5 CKD, as a result of less unrecognized disease and more complete claims

Summary

The prevalence of early to moderate CKD, the increasing prevalence of chronic conditions contributing to CKD and its associated morbidities, and the growing elderly population that is particularly vulnerable to CKD, all highlight the significant economic burden of CKD on patients, the health care system, and society. The importance of dedicating resources and efforts to better understand the true cost impact of disease and interventions that effectively reduce the prevalence and progression of

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    Financial support: None.

    Conflict of interest statement: Matthew Maciejewski owns stock in Amgen as a result of his spouse’s employment. Portions of data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US Government, Department of Veterans Affairs, or Duke University.

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