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Abstract：
BACKGROUND: The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.
METHODS: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.
RESULTS: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.
CONCLUSIONS: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.
METHODS: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.
RESULTS: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.
CONCLUSIONS: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.
摘要：
背景：北领地（NT）的慢性肾脏疾病（CKD）负担很高，澳大利亚。本研究旨在描述有CKD风险的人群的医疗保健使用和相关成本（例如，急性肾损伤，糖尿病,高血压,和心血管疾病）或在NT中患有CKD，从医疗保健资助者的角度来看。
方法：我们纳入了有以下风险的患者的回顾性队列：或者和CKD生活在一起，2017年1月1日。接受肾脏替代治疗的患者被排除在研究之外。数据来自领土肾脏保健数据库，使用来自公立医院和整个北领地的初级卫生保健服务的患者进行成本核算.年度医疗费用，包括医院,初级卫生保健,药物,和调查费用在一年的随访期内进行了描述。通过成本预测模型确定了与高年度医疗总费用相关的因素。
结果：在这项研究中纳入的37,398名患者中，23,419患有CKD的危险因素，而13,979患有CKD（1至5期，未接受肾脏替代疗法）。总体平均（±SD）年龄为45岁（±17），研究队列中有很大一部分是原住民（68％）。总体队列中常见的合并症包括糖尿病（36％），高血压（32%），和冠状动脉疾病（11%）。在有CKD风险的人群中，年度医疗费用最低（每人7,958澳元），在患有CKD5期的人群中最高（每人67,117澳元）。住院护理占所有医疗保健费用的大部分（76％）。年度医疗总费用增加的预测因素包括CKD的更高级阶段，和合并症的存在。在CKD第5阶段，与没有CKD的风险组的人相比，每人每年的额外费用为$53,634（95CI32,769至89,482，p<0.001）。
结论：CKD晚期的总医疗费用很高，即使病人没有透析.仍然需要针对CKD和相关慢性病症的有效一级预防和早期干预策略。
方法：我们纳入了有以下风险的患者的回顾性队列：或者和CKD生活在一起，2017年1月1日。接受肾脏替代治疗的患者被排除在研究之外。数据来自领土肾脏保健数据库，使用来自公立医院和整个北领地的初级卫生保健服务的患者进行成本核算.年度医疗费用，包括医院,初级卫生保健,药物,和调查费用在一年的随访期内进行了描述。通过成本预测模型确定了与高年度医疗总费用相关的因素。
结果：在这项研究中纳入的37,398名患者中，23,419患有CKD的危险因素，而13,979患有CKD（1至5期，未接受肾脏替代疗法）。总体平均（±SD）年龄为45岁（±17），研究队列中有很大一部分是原住民（68％）。总体队列中常见的合并症包括糖尿病（36％），高血压（32%），和冠状动脉疾病（11%）。在有CKD风险的人群中，年度医疗费用最低（每人7,958澳元），在患有CKD5期的人群中最高（每人67,117澳元）。住院护理占所有医疗保健费用的大部分（76％）。年度医疗总费用增加的预测因素包括CKD的更高级阶段，和合并症的存在。在CKD第5阶段，与没有CKD的风险组的人相比，每人每年的额外费用为$53,634（95CI32,769至89,482，p<0.001）。
结论：CKD晚期的总医疗费用很高，即使病人没有透析.仍然需要针对CKD和相关慢性病症的有效一级预防和早期干预策略。
