Association of Comorbidities with Healthcare Resource Utilization and Cost for Post-discharge Heart Failure Patients with Chronic Kidney Disease

Abstract

BACKGROUND: Heart failure is a serious and incurable condition that often coexists with chronic kidney disease. Approximately 83% of patients were hospitalized after their HF diagnosis, accounting for the majority of their medical costs. Numerous studies have reported that comorbidities are associated with HF hospitalization and costs. However, no study has been found so far that investigates the incremental economic burden of commonly reported comorbidities, namely diabetes, hypertension and coronary heart disease of post-discharge HF patients with chronic kidney disease. OBJECTIVE: To assess the incremental healthcare resource utilization and costs associated with additional comorbidities among post-discharge heart failure patients with chronic kidney disease, at 30-day and 1-year post discharge. METHODS: This retrospective cohort analysis was conducted using the IBM® Watson MarketScan® Commercial Claims and Encounters and Medicare Supplemental databases. Our population of interest was adult patients discharged after a HF hospitalization from Jan 1, 2011 to Dec 31, 2018, with concurrent chronic kidney disease with and without additional comorbidities of diabetes and/or hypertension and/or coronary heart disease. Primary outcome measures were incremental differences in healthcare resource utilization and total costs between heart failure patients with chronic kidney disease and heart failure patients with chronic kidney disease plus one or more comorbidities of diabetes, hypertension and coronary heart disease. Healthcare resource utilization was defined as hospital all-cause readmission, emergency room visit days, outpatient service visit days and unique drug categories of outpatient prescription fills. We separately evaluated patient out-of-pocket costs and payer costs. Multivariable regressions were used to assess outcomes of interest at 30-day post-discharge and a regression-based Kaplan Meier sample average method was used to evaluate each outcome over 1-year post-discharge. RESULTS: A total 71,612 patients were identified and included in the study. The mean age of patients ranged from 71.4 to 79.2. Additional comorbidities of diabetes with/without hypertension and/or coronary heart disease were associated with higher healthcare resource utilization at both 30-days and 1-year post discharge. Incremental differences found between groups in patient out-of-pocket cost 30-day post discharge are marginal. We found that individuals with co-occurring diabetes with/without hypertension and/or coronary heart disease incurred more out-of-pocket costs and payer costs 1-year post discharge. Patients with co-occurring coronary heart disease have similar healthcare resource utilization and total costs. In contrast, patients with co-occurring hypertension with or without coronary heart disease had similar healthcare resource utilization, and similar out-of-pocket costs but lower payer total costs. CONCLUSIONS: The number, as well as the type of comorbidities, impact the association between comorbidities and healthcare resource utilization and costs for post-discharge heart failure patients with chronic kidney disease. Diabetes is the comorbidity with the biggest impact in this study, which contributes to higher healthcare resource utilization and medical costs. Payers should focus on managing patients with diabetes to reduce medical costs for these patients.