OBJECTIVES : To evaluate therapeutic patterns and integrated costs of patients in haemodialysis with/without chronic kidney disease-associated pruritus (CKD-aP) from the Italian National Health Service (INHS) perspective.

METHODS : From the ReS database, through the cross-linkage of healthcare administrative data, patients with at least an hospitalization/outpatient specialist service for haemodialysis from 01/01/2015 to 12/31/2017 were selected (index date). Those with haemodialysis procedures during at least 2 years and not affected by chronic liver disease, cirrhosis, systemic lupus erythematosus and arterial vasculitis were categorized based on presence/absence of CKD-aP treatments, according to common clinical practice, in 180 days before index date. CKD-aP/non-CKD-aP cohorts were characterized in the accrual (gender, age) and in 2 previous years (comorbidities of interest). Costs were assessed over 1-year follow-up, while CKD-aP treatments also 1 year before.

RESULTS : Based on the above criteria, 1,239 patients were considered in the analysis (20.2% of all subjects in haemodialysis): 218 (17.6%) received at least a CKD-aP treatment, 1,021 did not. Patients were elderly (median age 71 CKD-aP vs 68 non- CKD-aP) and >50% males. CKD-aP subjects were more affected by comorbidities, especially hypertension (74.3% vs 71%), hyperphosphatemia (68.8% vs 61.0%), secondary hyperparathyroidism (46.8% vs 42.8%). One year before and after index date, CKD-aP treatments were supplied to 58.1% and 65.1% CKD-aP patients: 50% of them with antihistamines (24% cetirizine), 10% with gabapentin. Ultraviolet B therapy was administered to 1.4% in both periods, with frequencies doubling in follow-up). On average, a CKD-aP patient costed to the INHS €37,065 vs €35,988. In both cohorts outpatient specialist services accounted for 80.4%, of which >60% for haemodialysis.

CONCLUSIONS : Although patients potentially affected by CKD-aP resulted underestimated, they considerably weighed on healthcare resource consumption with significant related costs, mostly due to high efficiency dialytic therapies, suggesting that appropriate and effective treatments for this condition might offer cost offsets.