Cost of Potentially Preventable Hospitalizations Among Adults With Chronic Kidney Disease: A Population-Based Cohort Study

Abstract

Background: Prior studies report high hospitalization rates among patients with chronic kidney disease (CKD) and approximately 10% to 20.9% of hospitalizations are potentially preventable. Objective: To determine the rate, proportion, and cost of potentially preventable hospitalizations and whether this varied by CKD category. Design: Retrospective cohort study using population-based data. Setting: Alberta, Canada. Patients: All adults with an outpatient serum creatinine measurement between January 1 and December 31, 2017 in the Alberta Kidney Disease Network data repository. Measurements: CKD risk categories were based on measures of proteinuria (where available), eGFR, and use of dialysis. Patients were linked to administrative data to capture frequency and cost of hospital encounters and followed until death or end of study (December 31, 2018). The outcomes of interest were the rate and cost of potentially preventable hospitalizations, as identified using the Canadian Institute for Health Information (CIHI)-defined ambulatory care sensitive condition (ACSC) algorithm and a CKD-related ACSC algorithm. Methods: Unadjusted and adjusted rates per 1000-patient years, proportions, and cost attributable to preventable hospitalizations were identified for the cohort as a whole and for patients within each CKD risk category. Results: Of the 1,110,895 adults with eGFR and proteinuria measurements, 181,422 had CKD. During a median follow-up of 1 year, there were 62,023 hospitalizations among patients with CKD resulting in a total cost of $946 million CAD; 6907 (11.1%) of these hospitalizations were for CIHI-defined ACSCs while 4323 (7.0%) were for CKD-related ACSCs. Adjusted rates of hospitalization for ACSCs increased with CKD risk category and were highest among patients treated with dialysis. Among CKD patients, the total cost of potentially preventable hospitalizations was $79 million and $58 million CAD for CIHI-defined and CKD-related ACSCs (8.4% and 6.2% of total hospitalization cost, respectively). Limitations: Based on the ACSC construct, we were unable to determine if these hospitalizations were truly preventable. Conclusions: Potentially preventable hospitalizations have a substantial cost and burden on the health care system among people with CKD. Effective strategies that reduce preventable admissions among CKD patients may lead to significant cost savings. Trial registration: Not applicable—observational study design

Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives

“…This increase of cost across CKD stages calls for interventions that could slow kidney disease progression. Decreasing unnecessary hospitalizations can lower the cost of CKD [ 26 ]. A good follow-up of diabetic patients can prevent the progression of diabetic nephropathy [ 27 ], knowing that diabetes is causing 10% of the global health expenditure and kidney disease is one of the most expensive diabetic complications [ 28 ].…”

Emergency Department Use Among Adults Receiving Dialysis

“…With half of ACSC-related ED encounters resulting in hospital admission, the potential cost implications of our findings are significant, as patients receiving dialysis account for disproportionately high spending on both all-cause and kidney disease–specific ACSC hospitalizations compared with people with lower risk or no kidney disease. 46 Moreover, one-third of patients in our cohort had more than 3 ED encounters per year, reflecting a high-use subset of patients with more comorbidities, greater socioeconomic disadvantage, and increased likelihood of dying during follow up than low-frequency ED users. Thus, concerted health promotion efforts involving not only dialysis care teams but also community disciplines (eg, primary care, mental health services) are vital for addressing social determinants of health, promoting continuity of care, and managing complexity among those at risk for excess acute care use.…”

“…The unique requirement for dialysis both as life-sustaining therapy and to treat disease-related complications means that any proposed preventative care strategies should necessarily consider the imminence of dialysis need and supports (eg, resources, expertise) for safe, effective management.While understanding the risk factors of potentially preventable ED use is grounded in a need for targeted identification and intervention, high overall ED use in patients with kidney failure continues to burden health systems internationally. With half of ACSC-related ED encounters resulting in hospital admission, the potential cost implications of our findings are significant, as patients receiving dialysis account for disproportionately high spending on both all-cause and kidney disease-specific ACSC hospitalizations compared with people with lower risk or no kidney disease 46. Moreover, one-third of patients in our cohort had more than 3 ED encounters per year, reflecting a high-use subset of patients with more comorbidities, greater socioeconomic disadvantage, and increasedFigure 2.…”

Comparison of Acute Health Care Utilization Between Patients Receiving In-Center Hemodialysis and the General Population: A Population-Based Matched Cohort Study From Ontario, Canada

“…These studies have consistently found that individuals receiving maintenance dialysis frequently visit the emergency department or require hospitalization. 4 , 6 - 14 For example, Komenda et al 6 found the rate of emergency department visits in patients receiving dialysis was 8.5 times as high as the general population. However, these previous studies had limitations, including a lack of detailed information on multiple aspects of health care utilization (eg, emergency department visits, in-patient hospitalizations, and costs).…”