#2705 MEDICAL COST AND HEALTHCARE UTILIZATION IN ADULTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS IN A CHINESE REGIONAL DATABASE
Authors: Lin Yuwei , Xu Yang , Gao Pei 
Published: June 2023

Abstract

Background and Aims
The presence of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) leads to elevated medical and economic burden, and with CKD progression, the medical expenditure increases substantially. Information about healthcare utilization and medical expenditures of this patient population is limited in China. This study aims to describe the medical cost and healthcare utilization of patients with CKD and T2DM in a regional database in China.

Method
A retrospective, regional EHR-based serial cross-sectional study was conducted in Yinzhou Regional Healthcare Database (YRHCD), Ningbo, China. All adult patients (age &gt; = 18 years) with CKD and T2DM were collected between 1st Jan 2017 and 31st Dec 2020, patients were excluded if they did not have serum creatinine (SCr) values or initiated renal replacement therapy. Eligible patients were identified at each calendar year and categorified by CKD stages (G1-G5). Data on demographics, comorbidities and drug prescription were presented for all included patients at baseline and from 2017 to 2020. Annual medical costs and healthcare utilization were described among different CKD stages. Two-part models were built to estimate the medical costs and healthcare utilization in each CKD stage.

Results
A total of 16,521 patients with CKD and T2DM were included with a substantial increase between 2017 and 2020. Among all patients, the majority of them were classified in CKD stage 1 and 2. Over 70% of patients aged 65 years or older and approximately 55% were female. &gt;90% of patients had hypertension, followed by peripheral vascular diseases, which increased from 69.2% in 2017 to 82.2% in 2020. Renin–angiotensin system inhibitors (RASI) were the most prescribed medication and metformin ranked the second. In general, the age, proportion of having comorbidities and proportion of drug prescription presented an increasing trend from 2017 to 2020. The proportion of eGFR value &gt; = 25 and &lt; = 75 mL/min/1.73m2 in G1 to G4 was 64.4% for baseline and decreased from 58.2% in 2017 to 48.7% in 2020. The general trend of medical costs in all CKD stages increased from 2017 to 2020; for healthcare utilization, the average number of outpatient visits per person per year was over 10.0 times per each CKD stage. The medical cost and healthcare utilization increased substantially in patients with more advanced CKD stages. Mean annual medical costs per patients were 6,084, 8,675, 14,291, 24,971 and 42,580 CNY (908, 1,294, 2,132, 3,726 and 6,353 USD) and the mean length of stay were 2.2, 3.3, 6.2, 12.6 and 16.1 days for G1-5 patients respectively in 2020. Patients in G1 and G2 had more outpatient visits compared with hospitalization, the cost of hospitalization raised dramatically in patients with G4-G5 and became a main contributor of total medical cost.

Conclusion
Our contemporary study revealed the medical cost and use of healthcare resources increased moderately over time in earlier CKD stages but grew remarkably from G4 stage onwards. The estimates suggested significant correlation between CKD stages and medical costs and healthcare utilization. Our findings further suggest earlier CKD identification and timely treatment may reduce the overall medical and economic burden in this population.