PB1097 - Cost of major thrombotic cardiovascular events (MTCVE) among US patients with and without end-stage kidney disease (ESKD)

Background: Patients with ESKD (end-stage kidney disease) are at a higher risk of thrombotic and bleeding events and have higher healthcare utilization and costs compared with non-ESKD patients. There is limited information regarding the extent to which healthcare utilization and costs related to treating specific clinical events vary between ESKD and non-ESKD patients.

Aims: To assess and compare healthcare utilization and costs among Medicare fee-for-service (FFS) beneficiaries with, versus without, ESKD among those who experience major thrombotic cardiovascular events (MTCVEs) or major bleeding events.

Methods: Retrospective cohorts of patients aged ≥66 years were created using the US Renal Data System database (ESKD) and the 20% general Medicare database (non-ESKD). Patients experiencing a new MTCVE (myocardial infarction, ischemic stroke, venous thromboembolism, and critical limb ischemia, each examined separately) or a major bleeding event occurring between 2015 and 2018 were included. Healthcare utilization and costs were examined both prior to and following the index event for up to 1 year. Post-index costs were expressed in 2019 dollars and adjusted for demographics, comorbidities, and baseline costs.

Results: Baseline characteristics and total healthcare costs one year pre-index are described by event type in Table 1. Across all MTCVE subtypes and major bleeding events, index events were substantially costlier to treat among patients with ESKD than among those without. Over one year of follow-up, patients with ESKD incurred substantially higher inpatient costs as compared with non-ESKD patients with the same event type. This effect was attenuated but persisted (in both index hospitalization and 1-year inpatient hospitalizations) when fully adjusting for demographics and comorbidities.

Conclusion(s): Patients with ESKD experience a higher rate of healthcare encounters and incur substantially higher inpatient costs both during and in the year following major thrombotic cardiovascular events or major bleeding events compared to those without ESKD, even after adjustment.