Chronic Kidney Disease: Evolution of Healthcare Costs and Resource Consumption from Predialysis to Dialysis in Piedmont Region, Italy

This study aims at assessing the evolution in healthcare costs for chronic kidney disease (CKD) patients through the analysis of administrative databases of Piedmont region, Italy. This is a retrospective, observational study, for which patients undergoing at least one dialysis for CKD in the period of June 1, 2010–May 31, 2011 were selected. Two subpopulations were evaluated: patients incident-to-dialysis observed for the 12 months preceding dialysis entrance (PreD) and “established” dialysis patients (at least 120 dialyses/year) observed for 12 months (EstD). Overall, 1,059 PreD and 2,018 EstD patients were selected. The average yearly cost per PreD patient accounted for 11,123€ ± 15,095€ (75% hospitalizations, 17% drugs, and 8% diagnostic/therapeutic procedures). The average yearly cost per EstD patient accounted for 53,764€ ± 14,685€ (59% dialysis, 21% diagnostic/therapeutic procedures, 13% hospitalizations, and 6.7% drugs). Among EstD population, hemodialysis patients cost 56,049€ ± 13,473€ per year, whereas peritoneal dialysis patients cost 34,978€ ± 10,847€ per year. The significant difference in expenditure between predialysis and dialysis suggests that prevention, early diagnosis, and the consequent possible delay of dialysis entrance could lead to important savings for healthcare services, as well as a better global health status for patients. 1. Introduction Chronic kidney disease (CKD) is a common condition characterized by the loss of kidney function over time and is recognized as a major public health concern worldwide. In its 2014 fact sheet, the National Center for Chronic Disease Prevention and Health Promotion estimated that more than 20 million people in the US may have CKD at different levels and that in 2011 about 113,000 patients entered treatment for end stage renal disease (ESRD) [1]. Information consolidated from 150 countries worldwide showed a number of patients being treated globally for ESRD of 3,010,000 at the end of 2012 and the number of patients is growing faster than the world population (growth rate: 7%). At the end of 2012, haemodialysis (HD) was still the most common treatment modality, with approximately 2,106,000 patients (89% of all dialysis patients) and around 252,000 patients undergoing peritoneal dialysis (PD) (11% of all dialysis patients). At European level, the average growth rate of the dialysis patient population between 2011 and 2012 was about 2% [2]. The last report of the Italian Registry of Dialysis and Transplant (RIDT 2010) revealed a prevalence of HD and PD of 788 patients per million population