Incremental health care resource utilization and expenditures associated with autosomal dominant polycystic kidney disease

Abstract

Neeraj N Iyer,1 Nicholas J Vendetti,2 Daniel I Levy,3 Jack Mardekian,4 Marko A Mychaskiw,2 Joseph Thomas III1 1Regenstrief Center for Healthcare Engineering and Center for Health Outcomes Research and Policy, College of Pharmacy, Purdue University, West Lafayette, IN, USA; 2Outcomes and Evidence, Pfizer Inc., Collegeville, PA, USA; 3Rare Disease Group, Global Product Development, Pfizer Inc., Collegeville, PA, USA; 4Biostatistics, Global Product Development, Pfizer Inc., Collegeville, PA, USA Purpose: Incremental health care resource utilization and expenditures associated with autosomal dominant polycystic kidney disease (ADPKD) were estimated. Methods: Study data were from a large administrative claims database. Individuals aged 18 years or older enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an International Classification of Disease, Ninth Revision, Clinical Modification diagnosis code for “polycystic kidney, autosomal dominant” (753.13) or for “polycystic kidney, unspecified type” (753.12) were identified as having ADPKD, and linked one-to-one with individuals without ADPKD based on age and gender. Zero-inflated negative binomial models estimated incremental health care resource utilization and expenditures, adjusting for risk factors. Results: A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD. Multivariate, regression models adjusting for risk factors revealed incremental mean (standard error) resource use associated with ADPKD of 0.68 (0.090) hospital days, equal to 68 additional hospital days per 100 ADPKD patients, and 6.9 (0.28) outpatient visits, equal to 690 additional visits per 100 ADPKD patients. Mean (standard error) incremental total expenditures associated with ADPKD were US$8,639 ($470). Mean incremental expenditures were largest for outpatient expenditures at US$4,918 ($198), followed by mean incremental hospital expenditures of US$2,603 ($263), and mean incremental medication expenditures of US$1,589 ($77). Based on sub-group analysis, mean incremental total expenditures were US$2,944 ($417) among ADPKD patients without end-stage renal disease and US$38,962 ($6,181) for those with end-stage renal disease. Conclusion: ADPKD was associated with considerable incremental health care resource utilization and expenditures. Significant illness burden was found even before patients reached end-stage renal disease. Keywords: ADPKD, economic impact, disease burden, health care resource use, health care costs

Keywords

• ADPKD
• economic impact
• disease burden
• health care resource use
• health care costs