14-OR: The Cost of Chronic Kidney Disease Progression in Type 2 Diabetes Patients
Authors: BLONDE LAWRENCE , VASSALOTTI JOSEPH A. , PILON DOMINIC , WYNANT WILLY , ZHDANAVA MARYIA , LEFEBVRE PATRICK , VOELKER JENNIFER , BAILEY ROBERT , DURKIN MICHAEL 
Published: June 2019

This analysis assessed healthcare costs associated with progression of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D). Adults (&lt;85 years old) with T2D and ≥3 eGFR observations were identified in the Optum Clinformatics database (01/2010−09/2017). The first eGFR (index) following T2D diagnosis set the baseline CKD Stage: normal eGFR, Stage G3a, Stage G3b, or Stage G4. Stage G5 patients were excluded. CKD progression was defined by an eGFR indicating higher CKD Stage within 12 months of index and eGFR confirmation &gt;90 days later. Non-progression required an eGFR indicating same stage within 12 months and eGFR confirmation of same stage &gt;12 months post-index. Per-patient per-month (PPPM) healthcare costs evaluated from index to the earliest of end of eligibility or data were compared between progressors and non-progressors by baseline CKD Stage, and adjusted costs were compared using multivariate linear regressions. Of the 204,767 patients selected, 4.8% progressed ≥1 CKD Stage within a year. Progressors were older (72.5 vs. 64.5 years), more likely to be female (55.6% vs. 51.2%) and had a higher Diabetes Complications Severity Index (2.12 vs. 1.17) compared to non-progressors. Healthcare costs PPPM for progressors vs. non-progressors were $2,685 vs. $1,659 for baseline normal eGFR, $3,131 vs. $2,003 for G3a, $5,138 vs. $2,396 for G3b and $14,400 vs. $3,475 for G4. Among patients with confirmed progression status, progressors represented 4.1%, 8.5%, 5.5% and 4.2% of those from normal eGFR, G3a, G3b and G4, respectively. Controlling for baseline characteristics, the adjusted incremental post-index healthcare costs associated with progressors were $674 for baseline normal eGFR, $947 for G3a, $2,625 for G3b, and $10,704 for G4. All comparisons tested at p&lt;0.001. In patients with T2D, CKD progression was associated with increasingly higher incremental healthcare costs at each CKD stage, with the largest increase in cost observed from Stage G4 to Stage G5.

Disclosure
L. Blonde: Consultant; Self; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Research Support; Self; Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US. J.A. Vassalotti: Advisory Panel; Self; Merck & Co., Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., KPMG. D. Pilon: Other Relationship; Self; Janssen Scientific Affairs, LLC., Novartis Pharmaceuticals Corporation. W. Wynant: Consultant; Self; AbbVie Inc., Bristol-Myers Squibb Company, Daiichi Sankyo Company, Limited, Genentech, Inc., GlaxoSmithKline plc., Janssen Scientific Affairs, LLC., Novartis Pharmaceuticals Corporation, Novartis Pharmaceuticals Corporation, Taiho Pharmaceutical Co., Ltd. M. Zhdanava: Other Relationship; Self; Janssen Scientific Affairs, LLC., Novartis Pharmaceuticals Corporation. P. Lefebvre: Research Support; Self; Janssen Scientific Affairs, LLC. J. Voelker: Consultant; Self; Janssen Scientific Affairs, LLC. R. Bailey: Employee; Self; Janssen Scientific Affairs, LLC. Stock/Shareholder; Self; Johnson & Johnson. M. Durkin: Employee; Self; Janssen Scientific Affairs, LLC.

Funding
Janssen Scientific Affairs, LLC