ZHANG Ai-hua;ZHANG Dong-liang;YIN Dao-xin;DING Jia-xiang;DIAO Zong-li;CUI Wen-ying;ZHAO Wei;XU Rui;LIU Wen-hu.
2012, 28(8): 587-591.
Objective To evaluate the effect of cardiovascular disease (CVD) on the healthcare costs associated with chronic kidney disease (CKD). Methods A total of 96 patients with stage 3-4 CKD treated at CKD clinic of Beijing Friendship Hospital, Capital Medical University were enrolled in the study. Their mean age was (61.6±9.5) years including 65 male and 31 female patients. A retrospective analysis of clinical material and health claims between January 2010 and October 2010 was conducted. Firstly, patients were grouped according to median CKD-associated healthcare cost and clinical characteristics were compared between two groups. Secondly, patients were stratified into three categories based on CVD prevalence (with acute cardiovascular events, with CVD but no acute events, and without CVD), and CKD-associated healthcare costs were assessed among the groups. Finally, the potential factors influencing CKD-associated healthcare costs were evaluated by optimal scaling regression analysis. Results During January to October in 2010, median CKD-associated healthcare costs was 13 960.5 yuan (interquartile range 10 226.5, 19 667.2 yuan). In the group with higher healthcare costs, more females, greater urine albumin-creatinine ratio, more emergency observations and/or hospitalizations caused by acute cardiovascular events, higher diabetes mellitus prevalence and calcium-phosphorus products, and lower eGFR and hemoglobin levels were found (P<0.05, respectively). In contrast, the total prevalence of CVD was not significantly different between the groups (P=0.386). When grouping by CVD prevalence, significant differences of CKD-associated healthcare costs were observed only between patients with acute cardiovascular events and the other two groups (P<0.01, respectively). The median healthcare cost of the former was approximately twice as higher as that of the other two groups, and the maximal cost was also found in the acute-cardiovascular-event group. For the optimal scaling regression analysis, both emergency observations and/or hospitalizations caused by acute cardiovascular events and diabetes mellitus entered the equation, and standardized coefficients were -0.538 and -0.217 respectively (P<0.01 and P<0.05). Conclusions Emergency observations and/or hospitalizations caused by acute cardiovascular events are important factors inducing high CKD-associated healthcare costs in patients with stage 3-4 CKD. Therefore, the prevention of acute cardiovascular events may be favorable to reduce CKD-associated healthcare costs. Larger and longer-time perspective studies are required to confirm it. In addition, diabetes mellitus also influences CKD-associated healthcare costs.
