Skip to main content
Top
Published in: Pediatric Nephrology 9/2012

01-09-2012 | Original Article

Pharmaceutical cost distribution in childhood chronic kidney disease

Authors: Janis M. Dionne, Kelvin Lou, Lee Er, Kathleen Collin, Colin T. White

Published in: Pediatric Nephrology | Issue 9/2012

Login to get access

Abstract

Background

Chronic kidney disease (CKD) is associated with significant economic burdens to both patients and the healthcare system, but pharmaceutical cost analyses are uncommon despite drug therapy being a cornerstone of CKD management.

Methods

This observational, retrospective review of drug cost distribution at a single tertiary care pediatric nephrology program in Canada was conducted on prevalent patients with CKD aged 1 month to 20 years, between 1 January and 31 December 2009.

Results

The time-adjusted annual pharmaceutical cost of our cohort (n = 148) was just below US $250,000 with a cost per patient per year of $1,800. The highest costs were in the growth and nutrition category, followed by anemia, hypertension and bone metabolism. Total drug cost per patient increased as CKD stage advanced. Adherence was not demonstrated in any drug category, and the mean daily pill burden was nine (range 2–23).

Conclusions

This study has shown that while the annual pharmaceutical costs on a per patient basis are similar between children and adults, the cost distribution is very different. An increase in awareness of the unique needs of the pediatric population should allow for more cost-effective financial planning in pediatric CKD clinics.
Literature
1.
go back to reference Vupputuri S (2008) Epidemiology and costs of chronic kidney disease in North Carolina. N C Med J 69:205–214PubMed Vupputuri S (2008) Epidemiology and costs of chronic kidney disease in North Carolina. N C Med J 69:205–214PubMed
2.
go back to reference London R, Solis A, Goldberg G, Wade S, Chan W (2003) Examination of resource use and clinical interventions associated with chronic kidney disease in a managed care population. J Manag Care Pharm 9:248–255PubMed London R, Solis A, Goldberg G, Wade S, Chan W (2003) Examination of resource use and clinical interventions associated with chronic kidney disease in a managed care population. J Manag Care Pharm 9:248–255PubMed
3.
go back to reference Khan S, Amedia C Jr (2008) Economic burden of chronic kidney disease. J Eval Clin Pract 14:422–434PubMedCrossRef Khan S, Amedia C Jr (2008) Economic burden of chronic kidney disease. J Eval Clin Pract 14:422–434PubMedCrossRef
4.
go back to reference Smith D, Gullion C, Nichols G, Keith D, Brown J (2004) Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population. J Am Soc Nephrol 15:1300–1306PubMedCrossRef Smith D, Gullion C, Nichols G, Keith D, Brown J (2004) Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population. J Am Soc Nephrol 15:1300–1306PubMedCrossRef
5.
go back to reference van Hout B, Simeon G, McDonnell J, Mann J (1997) Economic evaluation of benazepril in chronic renal insufficiency. Kidney Int Suppl 63:S159–S162PubMed van Hout B, Simeon G, McDonnell J, Mann J (1997) Economic evaluation of benazepril in chronic renal insufficiency. Kidney Int Suppl 63:S159–S162PubMed
6.
go back to reference Ruggenenti P, Schieppati A, Remuzzi G (2001) Progression, remission, regression of chronic renal diseases. Lancet 357:1601–1608PubMedCrossRef Ruggenenti P, Schieppati A, Remuzzi G (2001) Progression, remission, regression of chronic renal diseases. Lancet 357:1601–1608PubMedCrossRef
7.
go back to reference Gregory D, Sarnak M, Konstam M, Pereira B, Salem D (2003) Impact of chronic kidney disease and anemia on hospitalization expense in patients with left ventricular dysfunction. Am J Cardiol 92:1300–1305PubMedCrossRef Gregory D, Sarnak M, Konstam M, Pereira B, Salem D (2003) Impact of chronic kidney disease and anemia on hospitalization expense in patients with left ventricular dysfunction. Am J Cardiol 92:1300–1305PubMedCrossRef
8.
go back to reference White C, Jaffey J, Magner P (2006) Cost of applying the K/DOQI guidelines for bone metabolism and disease to a cohort of chronic hemodialysis patients. Kidney Int 71:312–317PubMedCrossRef White C, Jaffey J, Magner P (2006) Cost of applying the K/DOQI guidelines for bone metabolism and disease to a cohort of chronic hemodialysis patients. Kidney Int 71:312–317PubMedCrossRef
9.
go back to reference St Peter W, Khan S, Ebben J, Pereira B, Collins A (2004) Chronic kidney disease: the distribution of health care dollars. Kidney Int 66:313–321PubMedCrossRef St Peter W, Khan S, Ebben J, Pereira B, Collins A (2004) Chronic kidney disease: the distribution of health care dollars. Kidney Int 66:313–321PubMedCrossRef
10.
go back to reference Lefebvre P, Duh M, Buteau S, Bookhart B, Mody S (2006) Medical costs of untreated anemia in elderly patients with predialysis chronic kidney disease. J Am Soc Nephrol 17:3497–3502PubMedCrossRef Lefebvre P, Duh M, Buteau S, Bookhart B, Mody S (2006) Medical costs of untreated anemia in elderly patients with predialysis chronic kidney disease. J Am Soc Nephrol 17:3497–3502PubMedCrossRef
11.
go back to reference Matsui D (1997) Drug compliance in pediatrics: clinical and research issues. Pediatr Clin North Am 44:1–14PubMedCrossRef Matsui D (1997) Drug compliance in pediatrics: clinical and research issues. Pediatr Clin North Am 44:1–14PubMedCrossRef
13.
go back to reference Hogg R, Furth S, Lemley K, Portman R, Schwartz G, Coresh J, Balk E, Lau J, Levin A, Kausz A, Eknoyan G, Levey A (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMedCrossRef Hogg R, Furth S, Lemley K, Portman R, Schwartz G, Coresh J, Balk E, Lau J, Levin A, Kausz A, Eknoyan G, Levey A (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMedCrossRef
14.
go back to reference Mattman A, Eintracht S, Mock T, Schick G, Seccombe D, Hurley R, White C (2006) Estimating pediatric glomerular filtration rates in the era of chronic kidney disease staging. J Am Soc Nephrol 17:487–496PubMedCrossRef Mattman A, Eintracht S, Mock T, Schick G, Seccombe D, Hurley R, White C (2006) Estimating pediatric glomerular filtration rates in the era of chronic kidney disease staging. J Am Soc Nephrol 17:487–496PubMedCrossRef
16.
go back to reference Steiner J, Koepsell T, Fihn S, Inui T (1988) A general method of compliance assessment using centralized pharmacy records: description and validation. Med Care 26:814–823PubMedCrossRef Steiner J, Koepsell T, Fihn S, Inui T (1988) A general method of compliance assessment using centralized pharmacy records: description and validation. Med Care 26:814–823PubMedCrossRef
17.
go back to reference Steiner J, Prochazka A (1997) The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol 50:105–116PubMedCrossRef Steiner J, Prochazka A (1997) The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol 50:105–116PubMedCrossRef
18.
go back to reference London R, Solis A, Goldberg G, Wade S, Ryu S (2002) Health care resource utilization and the impact of anemia management in patients with chronic kidney disease. Am J Kidney Dis 40:539–548PubMedCrossRef London R, Solis A, Goldberg G, Wade S, Ryu S (2002) Health care resource utilization and the impact of anemia management in patients with chronic kidney disease. Am J Kidney Dis 40:539–548PubMedCrossRef
20.
go back to reference Brand F, Smith R, Brand P (1977) Effect of economic barriers to medical care on patients’ noncompliance. Public Health Rep 92:72–78PubMed Brand F, Smith R, Brand P (1977) Effect of economic barriers to medical care on patients’ noncompliance. Public Health Rep 92:72–78PubMed
21.
go back to reference Pons R, Torregrosa E, Hernandez-Jaras J, Garcia H, Rius A, Calvo C, Sanchez-Canel J, Pin M, Mauduell F (2006) El coste de tratamiento farmacologico en la enfermedad renal cronica. Nefrología 26:358–364PubMed Pons R, Torregrosa E, Hernandez-Jaras J, Garcia H, Rius A, Calvo C, Sanchez-Canel J, Pin M, Mauduell F (2006) El coste de tratamiento farmacologico en la enfermedad renal cronica. Nefrología 26:358–364PubMed
22.
go back to reference Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590PubMed Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590PubMed
23.
go back to reference Fadrowski J, Pierce C, Cole S, Moxey-Mims M, Warady B, Furth S (2008) Hemoglobin decline in children with chronic kidney disease: baseline results from the chronic kidney disease in children prospective cohort study. Clin J Am Soc Nephrol 3:457–462PubMedCrossRef Fadrowski J, Pierce C, Cole S, Moxey-Mims M, Warady B, Furth S (2008) Hemoglobin decline in children with chronic kidney disease: baseline results from the chronic kidney disease in children prospective cohort study. Clin J Am Soc Nephrol 3:457–462PubMedCrossRef
24.
go back to reference Levin A, Bakris G, Molitch M, Smulders M, Tian J, Williams L, Andress D (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in paitents with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38PubMedCrossRef Levin A, Bakris G, Molitch M, Smulders M, Tian J, Williams L, Andress D (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in paitents with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38PubMedCrossRef
25.
go back to reference Chiu Y, Teitelbaum I, Misra M, de Leon E, Adzize T, Mehrotra R (2009) Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 4:1089–1096PubMedCrossRef Chiu Y, Teitelbaum I, Misra M, de Leon E, Adzize T, Mehrotra R (2009) Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 4:1089–1096PubMedCrossRef
26.
go back to reference Modi A, Lim C, Yu N, Geller D, Wagner M, Quittner A (2006) A multi-method assessment of treatment adherence for children with cystic fibrosis. J Cyst Fibros 5:177–185PubMedCrossRef Modi A, Lim C, Yu N, Geller D, Wagner M, Quittner A (2006) A multi-method assessment of treatment adherence for children with cystic fibrosis. J Cyst Fibros 5:177–185PubMedCrossRef
27.
go back to reference Fotheringham M, Sawyer M (1995) Adherence to recommended medical regimens in childhood and adolescence. J Paediatr Child Health 31:72–78PubMedCrossRef Fotheringham M, Sawyer M (1995) Adherence to recommended medical regimens in childhood and adolescence. J Paediatr Child Health 31:72–78PubMedCrossRef
29.
go back to reference Bailie G, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F, Wolfe R, Port F, Burrows-Hudson S, Saran R (2005) Patterns of medications use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrol Dial Transplant 20:1110–1115PubMedCrossRef Bailie G, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F, Wolfe R, Port F, Burrows-Hudson S, Saran R (2005) Patterns of medications use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrol Dial Transplant 20:1110–1115PubMedCrossRef
30.
go back to reference Tomasello S, Dhupar S, Sherman R (2004) Phosphate binders, K/DOQI guidelines, and compliance: the unfortunate reality. Dial Transplant 33:236–242 Tomasello S, Dhupar S, Sherman R (2004) Phosphate binders, K/DOQI guidelines, and compliance: the unfortunate reality. Dial Transplant 33:236–242
Metadata
Title
Pharmaceutical cost distribution in childhood chronic kidney disease
Authors
Janis M. Dionne
Kelvin Lou
Lee Er
Kathleen Collin
Colin T. White
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 9/2012
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-012-2165-1

Other articles of this Issue 9/2012

Pediatric Nephrology 9/2012 Go to the issue