Hemoglobin stability impact on healthcare resource utilization and costs among dialysis-dependent patients with anemia of end-stage kidney disease.

Background: The impact of hemoglobin stability on healthcare resource utilization (HCRU) and costs in dialysis-dependent patients with anemia of end-stage kidney disease (ESKD) was evaluated.

Methods: This retrospective, observational study used Optum's de-identified Market Clarity Data (Optum^® Market Clarity) (2017-2019). Dialysis-dependent patients with anemia of ESKD were stratified by mean hemoglobin level (below, within, or above the target range of 10.0-11.5 g/dL) and time within hemoglobin target range (TiR; high, ≥ 60% or low, < 60% of hemoglobin measurements within the target range) over a 9-month exposure assessment period following initiation of anemia treatment. Incidence rates of HCRU per-person year and annual mean costs were compared between groups weighted by inverse probability weighting during the outcomes assessment period (day after exposure assessment period until earliest of renal transplantation date, end of eligibility, or data availability [March 31, 2022], or death).

Results: Of 2,279 eligible patients, 37.1%, 44.1%, and 18.8% had mean hemoglobin levels below, within, and above the target range, respectively, and 78.2% had low TiR. Patients with hemoglobin levels within the target range had a significant cost reduction of $6,201 in red blood cell (RBC) transfusions, and significantly lower incidence of RBC transfusions (46%) and inpatient visits (20%) compared to those below the target range. Mean hemoglobin level within versus above the target range was associated with a significantly higher incidence rate of inpatient visits (14%) and annual costs ($1,958) for RBC transfusions. Patients with high versus low TiR had significantly lower incidence rate of RBC transfusion visits (43%) and inpatient visits (19%), and a significant total healthcare cost reduction of $33,921.

Conclusions: Increasing hemoglobin levels to within the target range, and having a higher TiR, was associated with positive impacts on RBC transfusion frequency, HCRU, and costs among dialysis-dependent patients with anemia of ESKD.

Clinical trial number: Not applicable.