Employer-sponsored group health plans remain the primary payer for patients who develop end-stage renal disease (ESRD) prior to qualifying for Medicare coverage, a study reported. This study identified the rate of new onset ESRD among a commercially insured population with type 2 diabetes (T2DM) and chronic kidney disease (CKD) and calculated total medical costs during the employer primary coverage period. The findings were published as a poster at the AMCP Nexus 2021.
Researchers used a commercial insurance claims database to identify patients aged 18 to 64 years with continuous eligibility in all of 2015 and at least one month of 2016. Newly onset ESRD identification was defined in this study as three consecutive months of outpatient dialysis or kidney transplant in 2016 and no ESRD claims in the 12 months (baseline) before the first ESRD claim in 2016 (index). Costs represented payer paid amounts before Medicare became the primary coverage and were trended to 2019 USD.
In total, 18,492,858 members met the eligibility criteria, and 2,059 of members were identified with newly onset ESRD. Around half (52.2%) of patients had T2DM and CKD at baseline, representing an annual ESRD transition rate of 1.3% for patients with these comorbidities.
Of the 1,074 members transitioning to ESRD in 2016, 81.3% were eligible for employer primary coverage because they did not turn 65 (i.e., meet Medicare eligibility) during the 33-month post-index period. Those who turned 65 during the post-index period had 16 months of exposure on average. The average annualized paid amount per patient for the post-index period was $256,000. This amount includes $47,000 for inpatient claims, $172,000 for outpatient claims (dialysis costs, $130,000, 51% of total), $24,000 for professional claims, and $13,000 for pharmacy claims.
“Members who develop ESRD contribute a significant burden to employer health care costs. Treatments delaying the progression of CKD to ESRD could reduce ESRD costs to employers,” the researchers concluded.
Source: Fitch K, et al. The Cost Burden to Employers of Type 2 Diabetes Members Transitioning to End-Stage Renal Disease. Poster E6.Published for AMCP Nexus 2021; October 18-21, 2021, Denver, CO.