Italian healthcare resource consumption for patients on hemodialysis treated for chronic kidney disease-associated pruritus (CKD-aP)
DOI:
https://doi.org/10.33393/grhta.2024.2696Keywords:
Costs, Dialysis, End-stage kidney disease, Italy, Retrospective analysis, RWE, Treatment, Uremic pruritusAbstract
Background: Chronic kidney disease-associated pruritus (CKD-aP) affects patients on hemodialysis. This study identified hemodialysis patients presumably affected or not affected by CKD-aP and integrated healthcare costs, from the perspective of the Italian administrative healthcare data.
Methods: Through cross-linkage of Italian administrative healthcare data collected between 2015 and 2017 (accrual period) in the database of Fondazione ReS (Ricerca e Salute), patients undergoing in-hospital/outpatient hemodialysis were selected. Cohorts with and without CKD-aP were created based on the presence/absence of CKD-aP-related treatment (according to common clinical practice and guidelines) supplies and assessed in terms of CKD-aP-related treatments and mean healthcare costs per capita paid by the Italian National Health Service (INHS).
Results: Of 1,239 people on hemodialysis for ≥2 years, CKD-aP affected 218 patients. Patients with CKD-aP were older and with more comorbidities. During the follow-up year, on average, the INHS spent €37,065 per case, €31,286 per control and € 35,988 per non-CKD-aP subject. High-efficiency dialytic therapies performed to people on hemodialysis with CKD-aP largely weighed on the overall mean annual cost.
Conclusions: This real-world study identified patients on chronic hemodialysis potentially treated for CKD-aP. Interestingly, high-efficiency dialysis seems the most frequent and expensive choice for the treatment of CKD-aP. The discovery of appropriate and effective treatments for this condition might offer cost offsets.
Downloads
References
Sukul N, Karaboyas A, Csomor PA, et al. Self-reported pruritus and clinical, dialysis-related, and patient-reported outcomes in hemodialysis patients. Kidney Med. 2020;3(1):42-53.e1. https://doi.org/10.1016/j.xkme.2020.08.011 PMID:33604539 DOI: https://doi.org/10.1016/j.xkme.2020.08.011
Kim D, Pollock C. Epidemiology and burden of chronic kidney disease-associated pruritus. Clin Kidney J. 2021 Oct;14(suppl 3):i1-i7. https://doi.org/10.1093/ckj/sfab142. DOI: https://doi.org/10.1093/ckj/sfab142
van der Willik EM, Lengton R, Hemmelder MH, et al. Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms—results from the RENINE/PROMs registry. Nephrol Dial Transplant. 2022;37(9):1731-1741. https://doi.org/10.1093/ndt/gfac022 PMID:35098998 DOI: https://doi.org/10.1093/ndt/gfac022
Kimata N, Fuller DS, Saito A, et al. Pruritus in hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS). Hemodial Int. 2014;18(3):657-667. https://doi.org/10.1111/hdi.12158 PMID:24766224 DOI: https://doi.org/10.1111/hdi.12158
Mettang T, Kremer AE. Uremic pruritus. Kidney Int. 2015;87(4):685-691. https://doi.org/10.1038/ki.2013.454 PMID:24402092 DOI: https://doi.org/10.1038/ki.2013.454
Millington GWM, Collins A, Lovell CR, et al. British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol. 2018;178(1):34-60. https://doi.org/10.1111/bjd.16117 PMID:29357600 DOI: https://doi.org/10.1111/bjd.16186
Weisshaar E, Szepietowski JC, Dalgard FJ, et al. European S2k guideline on chronic pruritus. Acta Derm Venereol. 2019;99(5):469-506. https://doi.org/10.2340/00015555-3164 PMID:30931482 DOI: https://doi.org/10.2340/00015555-3164
Ting SW, Fan PC, Lin YS, et al. Association between uremic pruritus and long-term outcomes in patients undergoing dialysis. J Am Acad Dermatol. 2020;83(3):924-925. https://doi.org/10.1016/j.jaad.2020.01.011 PMID:31940463 DOI: https://doi.org/10.1016/j.jaad.2020.01.011
Aresi G, Rayner HC, Hassan L, et al. Reasons for underreporting of uremic pruritus in people with chronic kidney disease: a qualitative study. J Pain Symptom Manage. 2019;58(4):578-586.e2. https://doi.org/10.1016/j.jpainsymman.2019.06.010 PMID:31228535 DOI: https://doi.org/10.1016/j.jpainsymman.2019.06.010
Istituto Nazionale di Statistica and ISTAT. Resident population by age, sex and marital status. 2015. https://www.istat.it/it/files//2016/02/Indicatori-demografici_2015.pdf. Accessed December 2023.
Piccinni C, Cevoli S, Ronconi G, et al. Insights into real-world treatment of cluster headache through a large Italian database: prevalence, prescription patterns, and costs. Expert Rev Clin Pharmacol. 2021;14(9):1165-1171. https://doi.org/10.1080/17512433.2021.1934448 PMID:34030566 DOI: https://doi.org/10.1080/17512433.2021.1934448
Maggioni AP, Dondi L, Andreotti F, et al. Prevalence, clinical impact and costs of hyperkalaemia: special focus on heart failure. Eur J Clin Invest. 2021;51(8):e13551. https://doi.org/10.1111/eci.13551 PMID:33786826 DOI: https://doi.org/10.1111/eci.13551
Ronconi G, Dondi L, Calabria S, et al. Real-world prescription pattern, discontinuation and costs of ibrutinib-naïve patients with chronic lymphocytic leukemia: an Italian healthcare administrative database analysis. Clin Drug Investig. 2021;41(7):595-604. https://doi.org/10.1007/s40261-021-01044-3 PMID:34032988 DOI: https://doi.org/10.1007/s40261-021-01044-3
WHO. Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2023. https://www.whocc.no/atc_ddd_index/. Accessed May 2023.
Ministero del Lavoro, della salute e delle politiche sociali. Classificazione delle malattie, dei traumatismi, degli interventi chirurgici e delle procedure dagnostiche e terapeutiche. Versione italiana della ICD9-CM. 2007. https://www.salute.gov.it/imgs/C_17_pubblicazioni_2251_allegato.pdf. Accessed December 2023.
CINECA—Interuniversity Consortium. https://www.cineca.it/. Accessed May 2023.
Società Italiana di Nefrologia. Registro italiano di dialisi e trapianto [Italian Registry of Dialysis and Transplantation]. https://ridt.sinitaly.org/. Accessed May 2023.
Verduzco HA, Shirazian S. CKD-associated pruritus: new insights into diagnosis, pathogenesis, and management. Kidney Int Rep. 2020;5(9):1387-1402. https://doi.org/10.1016/j.ekir.2020.04.027 PMID:32954065 DOI: https://doi.org/10.1016/j.ekir.2020.04.027
Simonsen E, Komenda P, Lerner B, et al. Treatment of uremic pruritus: a systematic review. Am J Kidney Dis. 2017 Nov;70(5):638-655. https://doi.org/10.1053/j.ajkd.2017.05.018 PMID:28720208 DOI: https://doi.org/10.1053/j.ajkd.2017.05.018
van Oosten MJM, Logtenberg SJJ, Edens MA, et al. Health claims databases used for kidney research around the world. Clin Kidney J. 2020;14(1):84-97. https://doi.org/10.1093/ckj/sfaa076 PMID:33564408 DOI: https://doi.org/10.1093/ckj/sfaa076
Agenzia Italiana del Farmaco. Nota 89. GU Serie Generale n.259 del 04-11-2004 2004. https://www.aifa.gov.it/nota-89. Accessed December 2023.
Agenzia Italiana del Farmaco. Nota 4. Farmaco in nota: duloxetina, gabapentin, pregabalin. https://www.aifa.gov.it/nota-04. Accessed December 2023.
Arzhan S, Roumelioti ME, Unruh ML. Itch and ache on dialysis: new approaches to manage uremic pruritus and restless legs. Blood Purif. 2020;49(1-2):222-227. https://doi.org/10.1159/000504081 PMID:31851986 DOI: https://doi.org/10.1159/000504081
Trachtenberg AJ, Collister D, Rigatto C. Recent advances in the treatment of uremic pruritus. Curr Opin Nephrol Hypertens. 2020;29(5):465-470. https://doi.org/10.1097/MNH.0000000000000625 PMID:32740217 DOI: https://doi.org/10.1097/MNH.0000000000000625
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 The authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to Global & Regional Health Technology Assessment agree to publish their articles under the CC-BY-NC 4.0 license, which allows third parties to re-use the work without permission as long as the work is properly referenced and the use is non-commercial.
Accepted 2023-11-29
Published 2024-01-15
