592 - Out of Pocket Spending and Health Care Utilization among Commercially Insured Children with Chronic Kidney Disease

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 592
Publication Number: 592.223

Nathaniel Putnam, University of Michigan Medical School, Ann Arbor, MI, United States; Kayla Sifre, University of Michigan Medical School, Ann Arbor, MI, United States; Eloise Salmon, University of Michigan Medical School, Ann Arbor, MI, United States; Kevin Dombkowski, University of Michigan Medical School, Ann Arbor, MI, United States; Debbie S. Gipson, University of Michigan, Ann Arbor, MI, United States; Zubin J. Modi, University of Michigan Medical School, Ann Arbor, MI, United States

Presenting Author(s)

Zubin J. Modi, MD, MS (he/him/his)

Assistant Professor
University of Michigan Medical School
Ann Arbor, Michigan, United States

Background: Children with chronic kidney disease (pCKD) have high inpatient health care utilization and costs compared to the pediatric chronic disease population. Comprehensive health care utilization and costs, particularly the burden of out-of-pocket (OOP) spending, have not been evaluated in this population.

Objective: To evaluate insurance reimbursed costs, out of pocket spending, and health care utilization among commercially insured pCKD patients in the US.

Design/Methods: All claims from the Truven MarketScan Commercial database for pediatric patients between 2009 and 2018, including subsequent adult data on transitioned pediatric patients within the study period, were included. pCKD patients were identified using established ICD-9/10 codes. Patients with less than 6 months of insurance coverage or records with used for soley administrative corrections were excluded. Both OOP and total insurance payments were calculated, as well as the number of outpatient visits (inclusive of emergency department visits), inpatient visits, and the length of each inpatient stay. Where CKD stage information was available, stratified OOP spending trends were evaluated.

Results: 212,705 (0.5%) of the pediatric population of 42,051,432 were identified as pCKD patients. 163,210 met the inclusion criteria. Patients had a median of 9.6 outpatient visits per year and 0.4 inpatient visits per year, with a median inpatient stay length of 2.3 days. The median pCKD patient spent 1 day in the hospital each year. The median total annual per patient cost to the insurer was $2,752 for outpatient care and $3,837 for inpatient care. The median OOP cost for a single inpatient visit was $536. The median insurance reimbursed cost for a single inpatient visit was $9,986. Overall, total OOP expenses for the pCKD population were $228,657,210. The median yearly OOP cost per patient was $682 with $474 for outpatient care and $208 for inpatient care. There was a relative stepwise increase in OOP spending and number of patient visits per year by CKD stage (Figures).

Conclusion(s):

Most pCKD patients receive the majority of their care as outpatients. While pCKD patients typically spend more OOP annually on outpatient versus inpatient services, a single inpatient stay surpasses these costs. OOP costs increase with worsening CKD stage, suggesting an added family burden with CKD progression. These findings highlight the importance of strategies to keep children with CKD out of the hospital when possible, recognizing the additional financial burdens added to the multiple difficulties hospitalized children with CKD face.