PM SOWA1,2, J ZHANG1,3, A CAMERON1,3, HG HEALY1,3,4, WE HOY1,3, LB CONNELLY1,2
1NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Australia, 2Centre for the Business and Economics of Health, The University of Queensland, Woolloongabba, Australia, 3Faculty of Medicine, The University of Queensland, Herston, Australia, 4Kidney Health Service, Metro North Hospital & Health Service, Queensland Health, Herston, Australia
Aim: To investigate characteristics and utilisation patterns of high-cost users (HCUs) of hospital care relative to non-HCU in patients with chronic kidney disease (CKD).
Background: CKD places a considerable burden on health care system resources, particularly on hospitals. In much medical data a small group of heavy users account for a disproportionately large share of expenditures. We retrospectively identified and characterised high-cost users (HCUs) of hospital care within a CKD cohort.
Methods: We analysed variables in HCU and non-HCU groups in patients from the CKD.QLD Registry, and their hospital admission records supplied by Queensland Health. We considered utilisation within 12 months after patients’ consent to the Registry. Those without a complete 12-month record were excluded from the analysis.
Results: Among 5,631 individuals, the top 10% of the most costly HCUs accounted for 71% of expenditures on admitted hospital care. 53% of the HCUs were frequent users (i.e. had more than 4 admissions for reasons other than dialysis). Dialysis accounted for 16% of expenditures within the HCU group and for 3% in other patients. HCUs were more likely to be male (59%vs54% non-HCU), to have advanced CKD (stages 4/5: 51%vs30% non-HCU) and to have comorbidities (diabetes and/or CVD: 78%vs62% non-HCU). HCUs also had considerably longer average lengths of stay (7.1 vs 2.3 days) and were more frequently admitted following an emergency presentation (49% of HCUs vs 43% of non-HCUs). One in 20 HCUs at year one remained HCU over 5 years.
Conclusions: These data allow identification of areas of high costs, and may inform design of clinical, epidemiological and policy responses. Data on nonsurvivors to one year, the likely highest costs users, are under analysis.
Dr Marcin Sowa is a Postdoctoral Research Fellow at the University of Queensland Centre for the Business and Economics of Health, and a health economist in the NHMRC Chronic Kidney Disease Centre of Research Excellence. Dr Sowa has led research projects in the areas of health care financing and insurance, health system governance, comparative healthcare systems, public health policy and, more recently, chronic kidney disease. He is a lecturer and course coordinator in health technology assessment and economic evaluation, and a member of the Medical Services Advisory Committee Evaluation Sub-committee (MSAC-ESC).