Health Care Resource Utilization and Costs of Major Adverse Thrombotic Events in Patients with and without ESKD.

Abstract

Background: Major adverse thrombotic events (MATEs) are an important cause of morbidity and mortality in people with end-stage kidney disease (ESKD) receiving dialysis. Information on the extent to which the healthcare resource utilization (HCRU) and costs of treating MATEs differ between the dialysis and non-dialysis populations is limited.

Methods: Fee-for-service Medicare beneficiaries aged ≥66 years who experienced a first (index) MATE in 2015-2018 were studied using an observation cohort design. Individuals with ESKD receiving dialysis from the US Renal Data System were compared to individuals without ESKD from a 20% Medicare sample. MATEs were identified using claims-based algorithms. Outcomes included HCRU and Medicare payments during the index MATE and during a 1-year follow-up period. Costs of maintenance dialysis were excluded. Age-, sex-, and race-adjusted outcomes were estimated using model-based standardization. Separately for each MATE type, outcomes were compared for each of two ESKD cohorts (in-center hemodialysis [ICHD] and home dialysis) vs. a non-ESKD cohort.

Results: Index MATE hospitalizations were roughly 1.2-1.3 times as long and 1.2-1.5 times as costly for patients with ESKD receiving ICHD (adjusted mean length of stay 7.0-10.3 days and cost $15.1K-$26.6K) than for patients without ESKD (5.6-7.6 days and $10.2K-$19.1K). Furthermore, in the 1-year follow-up, rates and per-person per-year costs of subsequent MATE-related hospitalizations were 2-3 times as high in patients receiving ICHD as in those without ESKD. HCRU and costs in patients receiving home dialysis were generally similar to, or higher than, in those receiving ICHD.

Conclusions: Among older adults with a MATE, those receiving dialysis had greater HCRU and costs compared to those without ESKD. Reducing HCRU and costs related to MATEs should be a focus of treatment for people receiving dialysis.