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Indicator Details: Annual Expenditures of CKD in the United States Medicare Population
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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

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The medical costs attributable to CKD increase as the severity of CKD increases. In order to prevent the significantly higher cost burden associated with later stages of the disease, these findings underscore the importance of identifying and treating CKD in the earlier stages. The medical costs attributable to CKD were calculated using a dataset that combined publicly available NHANES III data with Medicare claims from 1991 to 1994. 
Chart Explanation: The Medicare costs attributable to CKD for those with stages 2 through 4 of the disease were significantly higher than zero. The annual per person Medicare cost attributable to CKD was $1,600 for stage 1, $1,700 for stage 2, $3,500 for stage 3, and $12,700 for stage 4, adjusted to year 2010 dollars. These findings indicate the need to focus on treating earlier stages of the disease in order to prevent the higher cost burdens that are associated with later stages of the disease.
The National Center for Health Statistics (NCHS) Research Data Center (RDC) created a dataset that linked NHANES III data with data from Medicare claims for respondents who were Medicare beneficiaries. The reimbursements reported in the Medicare claims data reflect the actual payments made by the Medicare program, which include costs for inpatient, outpatient, emergency department, skilled-nursing facility, home health, durable medical equipment, and hospice care. The out-of-pocket spending and secondary insurance payments of Medicare beneficiaries were not included.

The Third National Health and Nutrition Examination Survey (NHANES III), 1988-94, contains data for 33,994 persons ages 2 months and older who participated in the survey. The NHANES is currently conducted every 2 years by the National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized U.S. civilian residents. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC).

This indicator is based upon analysis in published literature: Honeycutt AA, Segel JE, Zhuo X, et al. Medical costs of CKD in the Medicare population. J Am Soc Nephrol. 2013;24(9):1478-1483.
Description of MeasureAnnual Expenditures of CKD in the United States
Type of Data SourcePublic; restricted use
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 20 years or older
NumeratorParticipants with CKD who had both laboratory data from NHANES III and cost data from Medicare claims
DenominatorAll participants who had both laboratory data from NHANES III and cost data from Medicare claims
Definition of CKDStage of CKD was defined according to KDOQI guidelines by using the estimated GFR and the presence of albuminuria
Glomerular Filtration RateThe etimated GFR was calculated using serum creatinine values from NHANES that were standardized using the correction recommended by the NCHS and the four-variable simplified Modification of Diet in Renal Disease equation.
Primary Data Source IndicatorMedicare costs associated with CKD
Primary Indicator Method of MeasurementA logistic model was first used to estimate the probability of having positive Medicare costs; the investigators then used a generalized linear model with a gamma distribution and a log link to the estimate cost level results from the first model; the investigators controlled for eight comorbid conditions. 
Frequency of MeasurementOnce
Period Currently Available1988–1994
Pending DataNone
U.S. Region Covered by Primary VariableAll
Additional Data Items of InterestStage of CKD, year, other stratification variables of interest (diabetes by self-report, hypertension by self-report)
Limitations of IndicatorCosts examined are limited to those reimbursed by the Medicare program (i.e., do not include prescription drug costs or nursing home costs); CKD definition was based on NHANES III laboratory tests conducted during 1988-1994
Analytical Considerations
Appropriate NHANES survey weights must be used for all analyses; estimation of persistence of proteinuria can only be done at the population level; if SE 30% or more of estimate, must report as “low precision”
References and Sources:

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd