Chronic kidney disease and cardiovascular disease in Australia : a comparative cost analysis

Introduction: Cardiovascular disease (CVD) is the most expensive disease group in Australia, accounting for 11% of total healthcare expenditure. However, according to an Australian Institute of Health and Welfare (AIWH) report produced in 2011, CVD-related hospitalization rates, which account for nearly half of CVD-related cost, have fallen over the past decade. In contrast, the number of patients being treated for chronic kidney disease (CKD) has increased. Therefore, the aim of this study was to predict the overall cost per-patient cost associated with CKD and CVD. Methods: Data published by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the Australian Institute of Health and Welfare (AIHW) were used to compare CKD and CVD costs. Renal replacement therapy (RRT) costs were also examined as they are the primary contributor to CKD expenditure. Disease prevalence and cost predictions were made using a linear regression model. Results: CKD and RRT prevalence, per-patient expenditure, and overall expenditure are increasing more quickly than CVD. By 2020, the prevalence of RRT patients is estimated to increase by 29% (2012: 20,428, 95% CI: 14,215–26,640; 2020: 26,346, 95% CI: 15,950–36,742) compared to a 7% increase in CVD prevalence (2012: 3.5 M, 95% CI: 3.3M–3.8 M; 2020: 3.8 M, 95% CI: 3.4M–4.2 M). In this regard, CKD- and RRT-related expenditures are both estimated to increase by 41% (CKD: 2012: $1.5B, 95% CI: $1.2B–$1.9B; 2020: $2.2B, 95% CI: $1.6B–$2.8B) (RRT: 2012: $1.3B, 95% CI: $925M–$1.7B; 2020: $1.9B, 95% CI: $1.2B–$2.5B) compared to a 14% increase in CVD-related expenditure (2012: $6.9B, 95% CI: $6.7B–$7.1B; 2020: $7.8B, 95% CI: $7.4B–$8.2B). Furthermore, the average annual RRT patient cost is estimated to increase by 23% (2012: $68,027, 95% CI: $41,572–$94,483; 2020: $83,806, 95% CI: $39,573–$128,075) compared to an 8% increase in average annual CVD patient cost (2012: $1,956, 95% CI: $1,854–$2,058; 2020: $2,112, 95% CI: $1,938–$2,286). Discussion: The substantial healthcare costs associated with CVD are due to the large number of patients who suffer from this category of disease. When examined on a per-patient basis, CKD produces a considerably higher financial burden on Australia's healthcare system. Given the high per-patient cost and increasing prevalence of CKD, research focusing on novel prevention and/or therapeutic interventions is warranted. Individualized interventions, such as supervised exercise training, might be a cost-effective means of therapy for CKD patients.