HEALTHCARE BURDEN ACROSS UACR AND KIDNEY FUNCTION CATEGORIES IN CHRONIC KIDNEY DISEASE: A REAL-WORLD STUDY IN ENGLAND (THE PROMISE STUDY)
Author(s)
Heleen Van Haalen, MSc1, James O Burton, MD2, Tara Chang, MD, MS3, Roberto Pecoits-Filho, MD, PhD4, Maria K Svensson, MD, PhD5, Samuel Adamsson Eryd, PhD6, Unai Aranda, MD7, Johan Bodegård, MD, PhD8, Joshua Enxing, MSc9, Adeera Levin, MD, FRCPC10, Katherine Tuttle, MD11.
1Health Economics & Payer Evidence Lead, AstraZeneca, Mölndal, Sweden, 2University of Leicester, Leicester, United Kingdom, 3Stanford University School of Medicine, Stanford, CA, USA, 4Arbor Research Collaborative for Health, Ann Arbor, MI, USA, 5Uppsala University, Uppsala, Sweden, 6AstraZeneca, Gothenburg, Sweden, 7AstraZeneca, Gaithersburg, MD, USA, 8AstraZeneca, Oslo, Norway, 9AstraZeneca, Cambridge, United Kingdom, 10University of British Columbia, Vancouver, BC, Canada, 11University of Washington, Spokane, WA, USA.
1Health Economics & Payer Evidence Lead, AstraZeneca, Mölndal, Sweden, 2University of Leicester, Leicester, United Kingdom, 3Stanford University School of Medicine, Stanford, CA, USA, 4Arbor Research Collaborative for Health, Ann Arbor, MI, USA, 5Uppsala University, Uppsala, Sweden, 6AstraZeneca, Gothenburg, Sweden, 7AstraZeneca, Gaithersburg, MD, USA, 8AstraZeneca, Oslo, Norway, 9AstraZeneca, Cambridge, United Kingdom, 10University of British Columbia, Vancouver, BC, Canada, 11University of Washington, Spokane, WA, USA.
OBJECTIVES: Chronic kidney disease (CKD) is a major public health burden, affecting over 10% of the global population. Albuminuria is a key risk factor for CKD progression and has emerged as an important therapeutic target in CKD management. To inform economic evaluations of future interventions in CKD, we examined healthcare costs across a broad range of urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) categories among patients with CKD not receiving dialysis in England.
METHODS: Adults with CKD were identified using the Clinical Practice Research Datalink Aurum database in England, with linked Hospital Episode Statistics data to capture specialist and hospital costs. CKD was defined using laboratory and/or diagnostic criteria, and patients were stratified by UACR and eGFR categories. Individuals with type 1 diabetes were excluded. The index date was 1 January 2022, with a 1-year follow-up. Outcomes included mean cumulative reimbursed healthcare (hospital, specialist and primary care) costs per patient (total and CKD-related); medication costs were excluded. Patients were censored at dialysis initiation or death.
RESULTS: Among 169,921 patients with CKD (mean age 70-75 years across categories), a clear and consistent pattern was observed, with higher annual healthcare costs at higher UACR and lower eGFR. Economic burden was substantial, particularly in patients with UACR ≥700 mg/g (79 mg/mmol), with total and CKD-specific costs of ~£5,100-£16,900 and ~£1,200-£16,600 per year, respectively, depending on eGFR category. Costs were highest in patients with UACR ≥1,000 mg/g (≥113 mg/mmol) across most eGFR categories.
CONCLUSIONS: In this study, we stratified annual costs across eGFR and UACR categories in patients with CKD not receiving dialysis. In addition to the expected increase in costs associated with lower eGFR, higher levels of albuminuria were clearly associated with greater healthcare costs. These findings have important implications for future economic evaluations and decision-making in CKD.
METHODS: Adults with CKD were identified using the Clinical Practice Research Datalink Aurum database in England, with linked Hospital Episode Statistics data to capture specialist and hospital costs. CKD was defined using laboratory and/or diagnostic criteria, and patients were stratified by UACR and eGFR categories. Individuals with type 1 diabetes were excluded. The index date was 1 January 2022, with a 1-year follow-up. Outcomes included mean cumulative reimbursed healthcare (hospital, specialist and primary care) costs per patient (total and CKD-related); medication costs were excluded. Patients were censored at dialysis initiation or death.
RESULTS: Among 169,921 patients with CKD (mean age 70-75 years across categories), a clear and consistent pattern was observed, with higher annual healthcare costs at higher UACR and lower eGFR. Economic burden was substantial, particularly in patients with UACR ≥700 mg/g (79 mg/mmol), with total and CKD-specific costs of ~£5,100-£16,900 and ~£1,200-£16,600 per year, respectively, depending on eGFR category. Costs were highest in patients with UACR ≥1,000 mg/g (≥113 mg/mmol) across most eGFR categories.
CONCLUSIONS: In this study, we stratified annual costs across eGFR and UACR categories in patients with CKD not receiving dialysis. In addition to the expected increase in costs associated with lower eGFR, higher levels of albuminuria were clearly associated with greater healthcare costs. These findings have important implications for future economic evaluations and decision-making in CKD.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE278
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Urinary/Kidney Disorders