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1.
Am J Med Sci ; 358(2): 149-158, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331452

RESUMO

BACKGROUND: High out-of-pocket (OOP) cost is a barrier to healthcare access and treatment compliance. Our study examined high OOP healthcare cost and burden trends in adults with kidney disease (KD). METHODS: Using Medical Expenditure Survey 2002-2011 data, we examined the proportion of people greater than 17 years old with KD whose OOP burden was high. Trends by insurance status (private, public or none) and trends by income level (poor, low, middle or high income) were also examined in this study. RESULTS: Approximately 16% of people with KD faced high OOP burden in 2011. The proportion of adults with high OOP burden between 2002 and 2011 fell by 9.7 percentage points. The proportion of privately insured adults facing high OOP burden decreased by 4.7, those who were publicly insured 22.4, and those who were uninsured, 3.1 percentage points. The proportion of those facing high OOP burden who were poor/near poor fell by 26.5, those who had low income 13.4, and those who had middle income, 9 percentage points. CONCLUSIONS: Though high OOP burden declined between 2002 and 2011 in the US population with KD, most of the decline was among the publicly insured, so the uninsured populations with KD remain vulnerable. Providers and policy makers should be aware of the vulnerability of uninsured individuals with KD to high OOP burden.


Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde/tendências , Nefropatias/economia , Modelos Econômicos , Adolescente , Adulto , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estados Unidos , Adulto Jovem
2.
PLoS One ; 14(6): e0217696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216301

RESUMO

BACKGROUND: Approximately 28% of adults have ≥3 chronic conditions (CCs), accounting for two-thirds of U.S. healthcare costs, and often having suboptimal outcomes. Despite Institute of Medicine recommendations in 2001 to integrate guidelines for multiple CCs, progress is minimal. The vast number of unique combinations of CCs may limit progress. METHODS AND FINDINGS: To determine whether major CCs segregate differentially in limited groups, electronic health record and Medicare paid claims data were examined in one accountable care organization with 44,645 Medicare beneficiaries continuously enrolled throughout 2015. CCs predicting clinical outcomes were obtained from diagnostic codes. Agglomerative hierarchical clustering defined 13 groups having similar within group patterns of CCs and named for the most common CC. Two groups, congestive heart failure (CHF) and kidney disease (CKD), included 23% of beneficiaries with a very high CC burden (10.5 and 8.1 CCs/beneficiary, respectively). Five groups with 54% of beneficiaries had a high CC burden ranging from 7.1 to 5.9 (descending order: neurological, diabetes, cancer, cardiovascular, chronic pulmonary). Six groups with 23% of beneficiaries had an intermediate-low CC burden ranging from 4.7 to 0.4 (behavioral health, obesity, osteoarthritis, hypertension, hyperlipidemia, 'other'). Hypertension and hyperlipidemia were common across groups, whereas 80% of CHF segregated to the CHF group, 85% of CKD to CKD and CHF groups, 82% of cancer to Cancer, CHF, and CKD groups, and 85% of neurological disorders to Neuro, CHF, and CKD groups. Behavioral health diagnoses were common only in groups with a high CC burden. The number of CCs/beneficiary explained 36% of the variance (R2 = 0.36) in claims paid/beneficiary. CONCLUSIONS: Identifying a limited number of groups with high burdens of CCs that disproportionately drive costs may help inform a practical number of integrated guidelines and resources required for comprehensive management. Cluster informed guideline integration may improve care quality and outcomes, while reducing costs.


Assuntos
Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Nefropatias/epidemiologia , Medicare/economia , Múltiplas Afecções Crônicas/epidemiologia , Organizações de Assistência Responsáveis/economia , Idoso , Diabetes Mellitus/economia , Feminino , Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Humanos , Nefropatias/economia , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/economia , Estados Unidos
3.
J Vasc Access ; 20(1_suppl): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032732

RESUMO

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.


Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Nefropatias/terapia , Diálise Renal , Idoso , Angioplastia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/economia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Custos de Cuidados de Saúde , Humanos , Japão/epidemiologia , Nefropatias/diagnóstico , Nefropatias/economia , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/economia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Int J Cardiol ; 282: 53-58, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30518479

RESUMO

BACKGROUND: Nonvalvular atrial fibrillation (NVAF) is highly prevalent and increases the risks of cardiovascular events. In a recent subgroup analysis, treatment response was shown to vary for patients exhibiting worsening renal function (WRF) on-treatment. It is important to understand the cost-effectiveness of novel oral anticoagulant (NOAC) use in this population. METHODS: A cost-effectiveness analysis (CEA) was conducted using a Markov model to determine whether NOAC rivaroxaban treatment is cost-effective relative to warfarin in NVAF patients with on-treatment WRF. Input parameters were sourced from clinical literature including a multicenter clinical trial and subgroup analysis. We studied elderly US male patients at increased risk for stroke (CHADS2 score ≥ 2) undergoing treatment for NVAF and exhibiting WRF. Main outcome measures included total healthcare costs in 2017 US dollars (societal perspective), total quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and incremental net monetary benefits (INMB) per-patient. RESULTS: The remaining lifetime use of rivaroxaban is associated with 5.69 QALYs at a cost of $66,075 per patient, while warfarin produced 5.22 QALYs with costs of $78,504 per patient. At a willingness-to-pay (WTP) of $150,000 per QALY, incremental net monetary benefits (INMB) per patient are $83,590. In our population, treatment with warfarin was dominated by rivaroxaban in 99.4% of 10,000 simulations. CONCLUSIONS: Rivaroxaban is likely a dominant treatment over warfarin in elderly US male NVAF patients exhibiting WRF, providing increased QALYs at a decreased overall cost. Application of these findings may require healthcare providers to predict which patients are likely to exhibit WRF.


Assuntos
Fibrilação Atrial/economia , Análise Custo-Benefício/métodos , Nefropatias/economia , Rivaroxabana/economia , Varfarina/economia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Inibidores do Fator Xa/economia , Inibidores do Fator Xa/uso terapêutico , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/epidemiologia , Masculino , Rivaroxabana/uso terapêutico , Resultado do Tratamento , Varfarina/uso terapêutico
7.
Nephrology (Carlton) ; 24(4): 445-449, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29570911

RESUMO

AIM: Contemporary data on clinical and economic outcomes and quality of care amongst dialysis patients in India are not available. This pilot prospective study aimed to evaluate the feasibility of data collection and follow up within routine dialysis practice to inform setting up a dialysis registry. METHODS: An electronic instrument was developed to collect information on clinical and socio-demographic characteristics, outcome and out-of-pocket expenditure on incident patients commencing haemodialysis (HD) at two centres. Dialysis unit staff were trained in collecting and entering information on an electronic case record form. Patients were followed up at 1, 3, 6, 9 and 12 months to ascertain outcomes and treatment related costs. RESULTS: A total of 119 patients (37 females, age 47.5 ± 17.2 years) were enrolled. After 1 year, 38 (32%) patients were continuing on HD; 35 (29%) had died, 30 (25%) underwent a kidney transplant, and 16 (13%) had stopped dialysis. We noted a high prevalence of catastrophic health expenditure. Data collection was facilitated by appointing a designated staff member who received an incentive. Collection of financial information, clinical course for patients transferring out of the primary unit and the cause of death, when it occurred out of hospital was challenging. CONCLUSION: Prospective data collection of incident dialysis patients was feasible but is resource-intensive. High out-of-pocket costs force some patients to stop dialysis and can generate a sense of despair. Poor patient experiences and suspicion over the use of such data adversely affects collection of important clinical and health economic data.


Assuntos
Coleta de Dados , Países em Desenvolvimento/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Nefropatias/economia , Nefropatias/terapia , Diálise Renal/economia , Projetos de Pesquisa , Adulto , Idoso , Estudos de Viabilidade , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Incidência , Índia/epidemiologia , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Transplante de Rim/economia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Sistema de Registros , Diálise Renal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Perinatol ; 38(12): 1674-1684, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30237475

RESUMO

OBJECTIVE: We assessed survival, hospital length of stay (LOS), and costs of medical care for infants with lethal congenital malformations, and also examined the relationship between medical and surgical therapies and survival. STUDY DESIGN: Retrospective cohort study including infants born 1998-2009 with lethal congenital malformations, identified using a longitudinally linked maternal/infant database. RESULTS: The cohort included 786 infants: trisomy 18 (T18, n = 350), trisomy 13 (T13, n = 206), anencephaly (n = 125), bilateral renal agenesis (n = 53), thanatophoric dysplasia/achondrogenesis/lethal osteogenesis imperfecta (n = 38), and infants > 1 of the birth defects (n = 14). Compared to infants without birth defects, infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias had longer survival rates, higher inpatient medical costs, and longer LOS. CONCLUSION: Care practices and survival have changed over time for infants with T18, T13, bilateral renal agenesis, and skeletal dysplasias. This information will be useful for clinicians in counseling families and in shaping goals of care prenatally and postnatally.


Assuntos
Anormalidades Congênitas/economia , Anormalidades Congênitas/mortalidade , Anormalidades Congênitas/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Florida/epidemiologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Rim/anormalidades , Nefropatias/congênito , Nefropatias/economia , Nefropatias/mortalidade , Tempo de Internação/economia , Masculino , Anormalidades Musculoesqueléticas/economia , Anormalidades Musculoesqueléticas/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Síndrome da Trissomia do Cromossomo 13/economia , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/economia , Síndrome da Trissomía do Cromossomo 18/mortalidade
9.
J Manag Care Spec Pharm ; 24(10): 1052-1066, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30247099

RESUMO

BACKGROUND: Tenofovir disoproxil fumarate (TDF), a key component in many human immunodeficiency virus (HIV) treatment regimens, is associated with increased renal and bone toxicities. The contributions of such toxicities to treatment costs, as well as the relative differences in treatment costs for various TDF/emtricitabine (FTC) regimens, remains unexplored. OBJECTIVE: To estimate and compare mean overall and renal- and bone-specific costs, including total, inpatient, outpatient, and pharmacy costs in patients treated with TDF/FTC+efavirenz (EFV) compared with several non-EFV-containing TDF/FTC regimens. METHODS: We conducted a national cohort study of treatment-naive HIV-infected U.S. veterans who initiated treatment from 2003 to 2015 with TDF/FTC in combination with EFV, elvitegravir/cobicistat, rilpivirine, or ritonavir-boosted protease inhibitors (atazanavir, darunavir, or lopinavir). Outcomes of interest were quarterly total, inpatient, outpatient, and pharmacy costs using data from the Veterans Health Administration (VHA) electronic medical record and Managerial Cost Accounting System (an activity-based accounting system that allocates VHA expenditures to patient encounters). We controlled for measured confounders using inverse probability of treatment (IPT) weights and assessed differences using standardized mean differences (SMDs). For comparisons where SMDs exceeded 0.1 after IPT weighting, we used the more conservative matching weights in sensitivity analyses. For hypothesis testing, we compared IPT-adjusted differences in quarterly costs between treatment groups using Mann-Whitney U-tests and generalized estimating equation (GEE) regression models. RESULTS: Of 33,048 HIV-positive veterans, 7,222 met eligibility criteria, including 4,172 TDF/FTC + EFV recipients; mean (SD) age of the cohort was 50.0 (10.0) years; 96.7% were male; 60.1% were black; and 30.1% were white. Quarterly periods of exposure to EFV-containing regimens were 22,499 and of exposure to non-EFV-containing regimens were 11,633. After IPT weighting, absolute SMDs were < 0.1 except for a few covariates in the rilpivirine comparison. The per-patient adjusted mean total quarterly costs were $7,145 for EFV versus $8,726 for non-EFV (P < 0.001; Mann-Whitney U-test) and the per-patient adjusted mean difference in total quarterly costs was $1,419 lower for EFV versus all non-EFV combined (P < 0.001; GEE model). Corresponding values for outpatient costs ($2,656 vs. $2,942; P < 0.001; difference, -$254; P = 0.001), inpatient costs ($2,009 vs. $2,614; P < 0.001), radiology costs ($213 vs. $276; P < 0.001), and pharmacy costs ($2,480 vs. $3,170; P < 0.001; difference, -$600; P < 0.001) were all lower for EFV versus all non-EFV combined. Findings based on matching weights were qualitatively similar. Contributions of renal and bone costs to the total costs of treatment were very small, ranging between $52 and $94 per patient per quarter for renal outcomes and between $6 and $114 for bone outcomes. CONCLUSIONS: Among 7,222 HIV-treated veterans over an average follow-up of 1.2 years per patient, those patients receiving TDF/FTC + EFV had lower overall health care costs compared with those receiving non-EFV regimens. DISCLOSURES: This study was funded by Bristol-Myers Squibb. Nelson, Ma, Crook, Knippenberg, Nyman, and LaFleur are employees of the University of Utah, which received a grant from Bristol-Myers Squibb to conduct this study. Nyman also discloses honoraria for consulting from Otsuka and for writing a book chapter from Fresenius. La Fleur reports advisory board and consulting fees from Bristol-Myers Squibb outside of this study. Paul and Esker are employees of, and own stock in, Bristol-Myers Squibb.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/economia , Custos de Medicamentos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/efeitos adversos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/economia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Saúde dos Veteranos/economia , Adulto , Assistência Ambulatorial/economia , Doenças Ósseas/induzido quimicamente , Doenças Ósseas/economia , Doenças Ósseas/terapia , Quimioterapia Combinada , Feminino , Infecções por HIV/diagnóstico , Custos Hospitalares , Humanos , Nefropatias/induzido quimicamente , Nefropatias/economia , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/economia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , United States Department of Veterans Affairs/economia
10.
Clin J Am Soc Nephrol ; 13(4): 551-559, 2018 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-29545381

RESUMO

BACKGROUND AND OBJECTIVES: Incidence of ESKD is three times higher in black Americans than in whites, and CKD prevalence continues to rise among black Americans. Community-based kidney disease screening may increase early identification and awareness of black Americans at risk, but it is challenging to implement. This study aimed to identify participants' perspectives of community kidney disease screening. The Health Belief Model provides a theoretic framework for conceptualization of these perspectives and optimization of community kidney disease screening activities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Researchers in collaboration with the Tennessee Kidney Foundation conducted three focus groups of adults in black American churches in Nashville, Tennessee. Questions examined views on CKD information, access to care, and priorities of kidney disease health. Content analysis was used. Guided by the Health Belief Model, a priori themes were generated, and additional themes were derived from the data using an inductive approach. RESULTS: Thirty-two black Americans completed the study in 2014. Participants were mostly women (79%) with a mean age of 56 years old (range, 24-78). Two major categories of barriers to kidney disease screening were identified: (1) participant factors, including limited kidney disease knowledge, spiritual/religious beliefs, emotions, and culture of the individual; and (2) logistic factors, including lack of convenience and incentives and poor advertisement. Potential facilitators of CKD screening included provision of CKD education, convenience of screening activities, and use of culturally sensitive and enhanced communication strategies. Program recommendations included partnering with trusted community members, selecting convenient locations, tailored advertising, and provision of compensation. CONCLUSIONS: Findings of this study suggest that provider-delivered culturally sensitive education and stakeholder engagement are critical to increase trust, decrease fear, and maximize participation and early identification of kidney disease among black Americans considering community screening.


Assuntos
Afro-Americanos , Serviços de Saúde Comunitária , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Nefropatias/diagnóstico , Adulto , Afro-Americanos/psicologia , Idoso , Competência Cultural , Emoções , Feminino , Grupos Focais , Educação em Saúde , Acesso aos Serviços de Saúde , Humanos , Nefropatias/economia , Nefropatias/etnologia , Masculino , Pessoa de Meia-Idade , Motivação , Religião , Confiança , Adulto Jovem
13.
J Nephrol ; 31(1): 119-127, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28205136

RESUMO

In 2013, the Italian Society of Nephrology joined forces with Nephrocare-Italy to create a clinical research cohort of patients on file in the data-rich clinical management system (EUCLID) of this organization for the performance of observational studies in the hemodialysis (HD) population. To see whether patients in EUCLID are representative of the HD population in Italy, we set out to compare the whole EUCLID population with patients included in the regional HD registries in Emilia-Romagna (Northern Italy) and in Calabria (Southern Italy), the sole regions in Italy which have systematically collected an enlarged clinical data set allowing comparison with the data-rich EUCLID system. An analysis of prevalent and incident patients in 2010 and 2011 showed that EUCLID patients had a lower prevalence of coronary heart disease, peripheral vascular disease, heart failure, valvular heart disease, liver disease, peptic ulcer and other comorbidities and risk factors and a higher fractional urea clearance (Kt/V) than those in the Emilia Romagna and Calabria registries. Accordingly, survival analysis showed a lower mortality risk in the EUCLID 2010 and 2011 cohorts than in the combined two regional registries in the corresponding years: for 2010, hazard ratio (HR) EUCLID vs. Regional registries: 0.80 [95% confidence interval: 0.71-0.90]; for 2011, HR: 0.76 [0.65-0.90]. However, this difference was nullified by statistical adjustment for the difference in comorbidities and risk factors, indicating that the longer survival in the EUCLID database was attributable to the lower risk profile of patients included in that database. This preliminary analysis sets the stage for future observational studies and indicates that appropriate adjustment for difference in comorbidities and risk factors is needed to generalize to the Italian HD population analyses based on the data-rich EUCLID database.


Assuntos
Planos de Seguro com Fins Lucrativos , Nefropatias/terapia , Diálise Renal/efeitos adversos , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Pesquisa sobre Serviços de Saúde , Nível de Saúde , Humanos , Incidência , Itália/epidemiologia , Nefropatias/diagnóstico , Nefropatias/economia , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Diálise Renal/economia , Diálise Renal/mortalidade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Med Econ ; 21(3): 262-270, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29069948

RESUMO

AIMS: To estimate the economic burden of kidney disorders in Korea. MATERIALS AND METHODS: The economic burden of kidney disorders was estimated using a prevalence-based approach. Related kidney diseases in patients with kidney disorders (RPWKD) were defined using codes from the tenth International Classification of Disease (E70-E90, F30-F48, F60-F69, F90-F99, K65-K67, N00-N08, N17-N19, and N30-N39). All diseases in patients with kidney disorders (APWKD) were defined as kidney disorders that involved all disease codes. Economic costs were divided into direct costs (medical costs and non-medical costs) and indirect costs (productivity loss because of morbidity and premature mortality). RESULTS: The prevalence of kidney disorders increased from 0.08% (2008) to 0.11% (2011). The total economic burden of RPWKD also substantially increased from $898.9 million (2008) to $1.43 billion (2011). This ∼59.4% increase in the economic burden was equal to 0.12% of the Korean gross domestic product. The economic burden of APWKD also increased during the study period: $1.06 billion (2008), $1.23 billion (2009), $1.44 billion (2010), and $1.46 billion (2011). CONCLUSIONS: The present study provides the first data regarding the economic burden of kidney disorders in Korea. The findings support the need for early intervention services and prevention programs to prevent, identify, and manage kidney disorders.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Nefropatias/economia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Lactente , Classificação Internacional de Doenças , Nefropatias/classificação , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , República da Coreia , Adulto Jovem
17.
BMC Health Serv Res ; 17(1): 368, 2017 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28532412

RESUMO

BACKGROUND: This study examines trends in healthcare expenditure in adults with chronic kidney disease (CKD) and other kidney diseases (OKD) in the U.S. from 2002 to 2011. METHODS: One hundred and eighty-seven thousand, three hundred and fourty-one adults aged ≥18 from the Medical Expenditure Panel Survey (MEPS) Household Component were analyzed. CKD and OKD were based on ICD-9 or CCC codes. A novel two-part model was used to estimate the likelihood of any healthcare use and total expenditures. Covariates included individual demographics and comorbidities. RESULTS: Approximately 711 adults surveyed from 2002 to 2011 had CKD and 3693 had OKD. CKD was more likely among Non-Hispanic Blacks (NHB), Midwest and Western residents while OKD was more likely among Non-Hispanic Whites (NHW), Hispanics, married and Northeast residents. Both CKD and OKD were more likely in ≥45 years, males, widowed/divorced/single, ≤high school educated, publicly insured, Southern residents, poor and low income individuals. All comorbidities were more likely among people with CKD and OKD. Unadjusted analysis for mean expenditures for CKD and OKD vs. no kidney disease was $39,873 and $13,247 vs. $5411 for the pooled sample. After adjusting for covariates as well as time, individuals with CKD had $17,472 and OKD $5014 higher expenditures, while adjusted mean expenditures increased by $293 to $658 compared to the reference year group. Unadjusted yearly expenditures for CKD and OKD in the US population were approximately $24.6 and $48.1 billion, while adjusted expenditures were approximately $10.7 and $18.2 billion respectively. CONCLUSION: CKD and OKD are significant cost-drivers and impose a profound economic burden to the US population.


Assuntos
Efeitos Psicossociais da Doença , Gastos em Saúde/tendências , Insuficiência Renal Crônica/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Nefropatias/economia , Nefropatias/etnologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
18.
Nature ; 544(7648): 20-22, 2017 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-28383002

Assuntos
Grupo com Ancestrais do Continente Africano/genética , Genética Médica/tendências , Genômica/tendências , Medicina de Precisão/tendências , Saúde Pública/tendências , África/epidemiologia , África/etnologia , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/metabolismo , Fármacos Anti-HIV/uso terapêutico , Apolipoproteína L1 , Apolipoproteínas/genética , Benzoxazinas/administração & dosagem , Benzoxazinas/efeitos adversos , Benzoxazinas/metabolismo , Benzoxazinas/uso terapêutico , Instituições de Caridade/economia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Grupo com Ancestrais do Continente Europeu/genética , Predisposição Genética para Doença , Genética Médica/economia , Estudo de Associação Genômica Ampla/estatística & dados numéricos , Genômica/economia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/genética , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Nefropatias/economia , Nefropatias/epidemiologia , Nefropatias/genética , Nefropatias/terapia , Lipoproteínas HDL/genética , National Institutes of Health (U.S.)/economia , Neoplasias/genética , Neoplasias/radioterapia , Neoplasias/terapia , Polimorfismo de Nucleotídeo Único/genética , Medicina de Precisão/economia , Saúde Pública/economia , Inibidores da Transcriptase Reversa/efeitos adversos , Inibidores da Transcriptase Reversa/metabolismo , Inibidores da Transcriptase Reversa/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/genética , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/genética , Estados Unidos
19.
Am J Kidney Dis ; 70(1): 132-138, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28416322

RESUMO

As the costs of caring for patients with end-stage renal disease have grown, so has the pressure to provide high-quality care at a lower cost. Prompted in large part by regulatory and legislative changes, reimbursement is shifting from a fee-for-service environment to one of value-based payment models. Nephrologists in this new environment are increasingly responsible not only for direct patient care, but also for population management and the associated clinical outcomes for this vulnerable population. This Perspective article aims to recognize the key role and skills needed in order to successfully practice within these new value-based care models. The new paradigm of delivering and financing care also presents opportunities for nephrologists to shape how care is delivered, define meaningful quality metrics, and share in the financial outcomes of these approaches. Though it will take time, the training and mind-set of nephrologists must evolve to accommodate these expanded practice expectations required by a system that demands measurement, reporting, accountability, and improvement, not only for individuals but also for populations of patients.


Assuntos
Prestação Integrada de Cuidados de Saúde , Nefropatias/terapia , Nefrologia , Previsões , Custos de Cuidados de Saúde , Humanos , Nefropatias/economia , Modelos Teóricos , Papel do Médico
20.
Nephron ; 136(2): 54-61, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28214902

RESUMO

BACKGROUND/AIMS: Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. METHODS: This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. RESULTS: In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. CONCLUSIONS: Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs.


Assuntos
Hepatite C/complicações , Hepatite C/terapia , Nefropatias/complicações , Nefropatias/terapia , Adulto , Idoso , Comorbidade , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde , Hepatite C/economia , Humanos , Nefropatias/economia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Medicare , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
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