Healthcare resource utilisation and cost of care of systemic inflammation in individuals with atherosclerotic cardiovascular disease and chronic kidney disease
Authors: Rudolfsen J , Vukmirica J , Apecechea N S , Mortensen M B 
Published: October 2024

Abstract

Background
Atherosclerotic cardiovascular disease (ASCVD) is a chronic disease, progressed by localised or systemic inflammation (SI). Chronic kidney disease (CKD) facilitates the presence of SI and is associated with an increased risk of ASCVD. Previous studies have estimated that 1–2% of the population in Western countries suffer from both conditions.

Purpose
To investigates the healthcare costs and resource utilisation for individuals diagnosed with ASCVD and CKD, with or without SI.

Method
The study applied data from the Danish national health and administrative registries from 1994-2022. Patients with ASCVD were identified by ICD-10 codes. CKD was identified by eGFR [15-59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter date of diagnosis of the two diseases were used as index date. CRP-test results were extracted from RLRR. Individuals with conditions associated with CRP-levels and tests observed in association with CVD events or antibiotic/antiviral drug use were excluded. Individuals with at least two valid CRP tests were included. If two CRP-test results ≥2mg/L to &lt;20mg/L were observed less than six month apart, and within two years of index, the individuals were classified to have SI. Individuals diagnosed in the first year of available eGFR were excluded to ensure only incident individuals in the study. Outcomes included costs and use of inpatient (duration ≥12h) and outpatient (&lt;12h) hospital care, cost of primary care and prescription drugs (adjusted to 2022 currency). Results were derived using linear regression models.

Results
A total of 19,162 individuals’ incident between 2012-2022 were identified – 68% had SI. SI individuals had higher healthcare costs from five years before to three years after index. Individuals generated a total healthcare cost of EUR 69,554 (SI) and EUR 39,540 (no SI) in the study period (difference EUR 30,014, p&lt;0.001). In adjusted analysis, the attributable cost in the three years following index was 1.4 times higher for individuals with SI, compared to individuals with no SI (difference EUR 12,922, p&lt;0.001). Inpatient care accounted for 85% of the cost. SI individuals had significantly more inpatient hospital contacts from four years before to five years after index (7 attributable contacts total, 4.7 attributable contacts after index, 1.2 times more, p&lt;0.001), and more outpatient contacts from five years before to three years after index (6.2 attributable contacts total, 2.3 attributable contacts after index, 1.3 times more, p&lt;0.001). The largest difference was found in the year following index, where the difference was EUR 7,666 (1.5 times higher, p&lt;0.001) cost, 1.5 (1.3 times higher, p&lt;0.001) inpatient hospital contacts, and 1.1 (1.3 times higher, p&lt;0.001) outpatient hospital contacts (adjusted estimates).

Conclusion
Individuals with SI represent a significant burden to the healthcare system, both in terms of healthcare cost and healthcare resource utilisation.Total healthcare costsAttributable hospital contacts