#4543 EFFECT OF COMORBIDITIES ON HEALTHCARE EXPENDITURES FOR PATIENTS ON KIDNEY REPLACEMENT THERAPY IN A FRENCH COHORT
Authors: Vega Isabella Vanorio , Constantinou Panayotis , Bret Victor , Gentile Stephanie , Finne Patrik , Sautenet Bénédicte , Tuppin Philippe , Couchoud Cécile 
Published: June 2023

Abstract

Background and Aims
End stage kidney disease (ESKD) is associated with a substantial economic burden. In France, the cost of care for such patients represents 2.5% of the total French healthcare expenditures, but serves less than 1% of the population. These patients’ healthcare expenditures are high because of the specialized and complex treatment needed as well as the presence of multiple comorbidities. This study aims to describe and assess the effect of comorbidities on healthcare expenditures (direct medical cost and non-medical costs including transportation and compensatory allowances) for patients with ESKD in France, while considering the modality and duration of renal replacement therapy (RRT).

Method
This retrospective observational study included adults who started RRT for the first time between 2012 and 2014 in France and were followed for 5 years. Linear models were built to predict mean monthly cost (MMC) by integrating first the time duration in the cohort, then patient characteristics and finally the duration of use of each treatment modalities. A complementary analysis stratified on age group was also performed. The variables included in this analyses were: body mass index, age, sex, RRT modality, time in the cohort, coronary artery disease, heart failure, chronic respiratory disease, active cancer, diabetes, lower-limb arterial disease, HIV/AIDS, abdominal aneurism, rhythm disorders, stroke or transient ischemic attack, liver disease, mobility limitations. All RRT modalities available in France were also included: renal transplant (RT), hemodialysis (HD) in center, HD in self-care unit, HD in out-center, HD at home, assisted continuous ambulatory peritoneal dialysis (aCAPD), non-assisted continuous ambulatory dialysis (naCAPD), assisted automated peritoneal dialysis (aAPD), non-assisted automated peritoneal dialysis (naAPD).

Results
A total of 22,506 patients were included in the study. The mean MMC was 6,391€ (95% CI 6,345-6,438 €). The comorbidities with the highest effect on MMC were inability to walk +1,434€ (95% CI 1,434-1,434€), lower-limb arterial disease stage III-IV 777€ (95% CI 777-777€), active cancer +594€ (95% CI 594-594€), HIV positivity +507€ (95% CI 507-507€), and diabetes +395€ (95% CI 395-395€). Other comorbidities were also positively associated with MMC. KT and naAPD were negatively associated with the MMC by -161€ (95% CI -161 - -161€) and -2€ (95% CI -2 - -2€). The remaining RRT modalities were positively associated with the MMC. Hemodialysis in center had the highest effect on the MMC, adding 291€ (95% CI 291-291€). An age-stratified analysis showed an interaction between age groups and comorbidities. The presence of diabetes, cancer and respiratory disease had a great impact on MMC in younger patients.

Conclusion
This study confirms the importance of considering patient characteristics, comorbidities and type of RRT when assessing healthcare expenditures for patients with ESKD. Better care of comorbidities prior to RRT could reduce cost for individual patients as well as potentially reduce the incidence of patients in ESKD. Even though the Euro value is specific to France, other countries might benefit from evaluating and anticipating healthcare costs for patients in RRT by assessing patient comorbidities.