Chronic kidney disease in Spain: analysis of patient characteristics, incidence and direct medical costs (2011–2017)

Abstract

Objectives: To review the characteristics of patients with chronic kidney disease (CKD) who attended primary and specialized care centers in Spain, and to analyze patients' use of medical resources and direct medical costs of specialized care. Methods: Records of patients with CKD admitted to primary and specialized healthcare centers in Spain between 2011 and 2017 from two national discharge databases were analyzed in a retrospective multicenter observational study. Records were classified into one-to-five CKD stages plus a 5b stage, indicating end-stage renal disease. Results: Most of the patients registered in hospital settings were in stage 5. Registered secondary conditions included hypertensive chronic kidney, diabetes, anemia, hypercholesterolemia, and hypertension. The number of cases registered in primary care settings increased over time, whereas in specialized care centers incidence decreased; hospital incidence of CKD in 2017 was 10.72 per 10,000 persons. Mean in-hospital mortality was 5.90%, which remained stable during the study period. Mortality was associated with respiratory and heart failure. Mean length of hospital stay was 8.19 days, decreasing over the study period, whilst increasing with CKD progression. Mean annual direct medical cost of specialized care was e10,436 per patient. Complications of a transplant and bacterial infections were responsible for major increases in medical costs, that otherwise decreased over the study period. Conclusions: The costs of specialized care decreased with the length of hospital stay reduction. Cardiovascular risk factors were crucial in in-hospital mortality. This study provides population-based data to assist decision-makers at the national level and to contribute to worldwide evaluations and disease surveillance.

Cost‐effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain

“…Unitary resource costs were obtained from local databases with cost information. 26,27 Disease management cost were identified in scientific literature [27][28][29][30] (Table 4). All costs are expressed in euros (€), A structured questionnaire that included the values identified in the scientific published literature was designed and individually filled by each of the experts.…”

“…T A B L E 3 Markov model transition probabilities per 3-month model cycle. €549.13 28,30 MI follow-up in patients with CKD stage 3b-4 with AKI € 2,881.16 29,30 Abbreviations: AKI, acute kidney injury; CKD, chronic kidney disease; MI, myocardial infarction.…”

“…Unitary resource costs were obtained from local databases with cost information 26,27 . Disease management cost were identified in scientific literature 27–30 (Table 4). All costs are expressed in euros (€), in 2022 year values, updated with consumer price index stablished by National Statistics Institute 31 when appropriate.…”

Costs and healthcare utilisation of patients with chronic kidney disease in Spain

“…Other contributors to total CKD cost included primary care visits, specialized visits, and diagnostic tests. It has been reported that not only the costs of specialized care decrease with the length of hospital stay reduction [ 19 ], but also a nephrologist/nurse-based multifaceted intervention for stage 3 to 4 CKD patients may be a cost effective approach [ 49 ], suggesting that an integrated management of CKD patients in both specialist and primary care settings is warranted to reduce CKD burden.…”

“…Increasing the knowledge about CKD-related costs is mandatory to ascertain how CKD management can be improved, leading to a significant decrease in CKD burden [ 5 , 11 – 18 ]. Unfortunately, data about the impact of CKD on health care costs in Spain are scarce, and most importantly, not focused on a comprehensive approach [ 19 , 20 ].…”