Timeliness of Documentation and Costs of Care in Adults Newly Diagnosed with CKD

Background: Among persons with new onset chronic kidney disease (CKD), previous research has found considerable delay between laboratory evidence and documented diagnosis of the condition. However, the consequences of diagnostic delay are not known. Among adults with laboratory evidence (two estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 measured between 3-12 months apart) and a documented diagnosis of CKD (using ICD 9/10 codes), the study described the mean annual costs, among those with a documentation of the diagnosis within six months (“timely”), and greater than six months (“delayed”) of laboratory-based CKD. Methods: A retrospective longitudinal cohort study was conducted using 2009-2020 Optum® Market Clarity electronic health record-linked claims data among adults with an incident diagnosis of CKD. The study computed the mean total annual costs, which included direct medical (inpatient, outpatient, emergency department) costs and pharmacy costs (in 2022 United States Dollars) between cohorts stratified by the timing of CKD diagnosis. Mean annual costs for each component were calculated by dividing the costs incurred during follow up for each patient divided by the number of years of follow-up that the patient contributed, and represented cost per patient per year. Results: A total of 193,539 individuals with incident diagnosis of CKD were included; of them, 55,154 (28.5%) had a timely documented diagnosis of CKD, while 138,385 (71.5%) recorded a delayed documentation. The mean (SD) total annual costs were $46,030 (194,293) among those with timely diagnosis, and $50,151 (463,278) among the delayed cohort. Breaking down those totals, the annual mean medical costs were $37,054 (190,103) among those with timely diagnosis, and $41,007 (461,608) with delayed diagnosis. The mean annual pharmacy costs were $8,977 (31,296) and $9,145 (30,035) in timely diagnosed and delayed cohorts, respectively. Conclusion: In large cohort of US adults with incident CKD, our descriptive analysis found that, less than 30% had a timely documentation, and incurred lower costs than the cohort with delayed documentation. While this could be partially driven by the selection of patients in the timely and delayed groups, our preliminary findings suggest the need for timely documentation of CKD. Funding: Commercial Support - Boehringer Ingelheim

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