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The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers
Kathryn Fitch1, J Michael Woolley2, Tyler Engel3
1Principal, Milliman, New York, NY.
Insights
Hyperkalemia significantly increases healthcare costs and mortality, especially in patients with chronic kidney disease (CKD). This study quantifies the substantial clinical and economic burden in US Medicare and commercially insured populations.
Area of Science:
- Nephrology
- Pharmacoeconomics
- Epidemiology
Background:
- Hyperkalemia, characterized by elevated serum potassium levels (>5.0 mEq/L), is frequently observed in patients with chronic kidney disease (CKD).
- It is often linked to diminished kidney function and medications impacting the renin-angiotensin-aldosterone system.
Purpose of the Study:
- To determine the prevalence, comorbidities, mortality rates, healthcare utilization, and associated costs of hyperkalemia.
- This analysis focuses on US Medicare fee-for-service and commercially insured populations using real-world claims data.
Main Methods:
- A retrospective analysis of 2014 claims data from Medicare and MarketScan Commercial databases.
- Hyperkalemia and comorbidities were identified using ICD-9-CM codes. Mortality and costs were analyzed, with separate analyses for CKD subgroups.
Main Results:
- Hyperkalemia prevalence was 2.3% in Medicare and 0.09% in commercially insured populations.
- Patients with hyperkalemia, particularly those with CKD, exhibited significantly higher mortality rates and more than double the healthcare costs compared to those without hyperkalemia.
- Inpatient care constituted over 50% of the costs for CKD patients with hyperkalemia.
Conclusions:
- Hyperkalemia imposes a considerable clinical and economic burden on both Medicare and commercially insured individuals in the US.
- Effective management strategies for hyperkalemia are crucial to mitigate its impact on patient outcomes and healthcare expenditures.
Background:
Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD).
Objective:
To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost.
Methods:
A descriptive, retrospective claims data analysis was performed on patients with hyperkalemia using the 2014 Medicare 5% sample and the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounter databases. The starting study samples required patient insurance eligibility during ≥1 months in 2014. The identification of hyperkalemia and other comorbidities required having ≥1 qualifying claims in 2014 with an appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code in any position. To address the differences between patients with and without hyperkalemia, CKD subsamples were analyzed separately. Mortality rates were calculated in the Medicare sample population only. The claims were grouped into major service categories; the allowed costs reflected all costs incurred by each cohort divided by the total number of member months for that cohort.
Results:
The prevalence of hyperkalemia in the Medicare and commercially insured samples was 2.3% and 0.09%, respectively. Hyperkalemia was associated with multiple comorbidities, most notably CKD. The prevalence of CKD in the Medicare and the commercially insured members with hyperkalemia was 64.8% and 31.8%, respectively. After adjusting for CKD severity, the annual mortality rate for Medicare patients with CKD and hyperkalemia was 24.9% versus 10.4% in patients with CKD without hyperkalemia. The allowed costs in patients with CKD and hyperkalemia in the Medicare and commercially insured cohorts were more than twice those in patients with CKD without hyperkalemia. Inpatient care accounted for >50% of costs in patients with CKD and hyperkalemia.
Conclusion:
Hyperkalemia is associated with substantial clinical and economic burden among US commercially insured and Medicare populations.
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