番茄社区

ORLANDO -- Costs of care for patients with chronic kidney disease (CKD) are rising among the U.S. veteran population, researchers reported here.

Rajiv Saran, MD, of the University of Michigan, and colleagues found the total cost of CKD care in the Department of Veterans Affairs healthcare system increased from $12 billion in 2006 to $19 billion in 2014 in current dollars. Adjusted for inflation, the increase was 26%, the researchers reported as a late-breaking abstract at the .

More than three-fourths of the VA's aggregate spending each year on CKD patients was dedicated to patients with either stage 3a or 3b disease. However, the average cost per patient to treat increased with each worsening stage of CKD, with non-dialysis stage 5 CKD being the most expensive.

"It's trying to build a data system within the VA, for the VA -- for use, for quality improvement, [for the] researcher, and for day-to-day management of patients, eventually," Saran told 番茄社区 during an interview, noting the 3-year effort is the first of a multi-phase project.

Saran and colleagues established the VA Renal Information System (VA-REINS) by pooling individual electronic medical records from the VA Corporate Data Warehouse, as well as several other sources such as the IPEC Dialysis Dashboard, VA Medicare Linked Data, and National Centers for Medicare and Medicaid Services (CMS) ESRD data sources.

About 7 million VA patients are included in the VA-REINS system, all of whom visited a VA facility at least once during a span of three federal fiscal years and still alive during the beginning of the current fiscal year. There were 1.1 million (16%) VA users identified as having CKD through a restrictive definition, which included a persistent eGFR of less than 60 mL/min/1.73 m², with any evidence of proteinuria marked by severe or moderate AER/ACR/PCR/PER, or an ICD-9 diagnosis.

"But you know, if you use a strict definition, you are at risk of missing people," Saran noted. "And if you care about population health management in the VA, then you don't want to miss people that have the condition. Because health system recognition depends on the physician's testing them, suspecting the condition, and so if they don't, they miss the condition." Consequently, the researchers also conducted a second analysis using a broader definition of CKD in order to "cast a wider net to identify people who may be at risk of CKD, or may actually have CKD and may not be showing up in the healthcare system," he said.

These were patients meeting the previous criteria as well as those with just one eGFR measurement of less than 60 ml/min/1.73 m² in an outpatient setting. In that scenario, some 2.5 million VA patients (36% of the total) were defined as having CKD. Because the VA population is a very "high prevalence, high risk population," Saran highlighted these rates are likely more indicative of the pooled population.

These findings helped to prioritize CKD as an important clinical issue for the VA, Saran suggested, stating the high costs associated with CKD were previously unknown to the organization. Additionally, the newly established VA-REINS has great potential for population-based cost tracking, as well as disease management, surveillance, and prevention. In the future, the system is slated to have the ability to deliver individualized care for patients with physician reports, as well. Saran also suggests the model of the system has a wide-range of clinical applicability, such as for other chronic conditions or communicable diseases.

The research team noted plans to submit the findings for publication in the near future.

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