Health Care Costs Associated with the Development and Combination of Cardio-Renal-Metabolic Diseases

KEY POINTS: Onset of any new cardio-renal-metabolic condition drove substantial increase in health care costs. Overall costs increased by $10,316 (130%) when CKD developed, $6789 (84%) for type 2 diabetes, $21,573 (304%) for atherosclerotic cardiovascular disease, and $36,522 (475%) for heart failure. However, as a result of prediagnosis costs being higher as more conditions were present, the percentage increases in costs associated with incidence were lower when more prevalent conditions existed. BACKGROUND: The cardio-renal-metabolic (CRM) syndrome is a constellation of conditions which includes atherosclerotic cardiovascular disease, heart failure (HF), CKD, and type 2 diabetes. The economic consequences of developing each of these comorbidities in the context of the others have not been studied. METHODS: We used the electronic medical records of Kaiser Permanente Northwest to identify 387,985 members aged 18 years or older who had a serum creatinine measured between 2005 and 2017. Patients were followed through 2019. We used a statistical approach that assesses time dependency for continuous measures; the total observation period for each patient was divided into quarters (91-day increments), and each patient contributed a record for every quarter in which they were members of the health plan. CRM status was determined for each quarter. RESULTS: The incremental annualized cost of each of these chronic diseases was similar regardless of which other conditions were present when the new condition developed. Overall costs increased by $10,316 (130%) when CKD developed, $6789 (84%) for type 2 diabetes, $21,573 (304%) for atherosclerotic cardiovascular disease, and $36,522 (475%) for HF. However, as a result of prediagnosis costs being higher as more conditions were present, the percentage increases in costs associated with incidence were lower when more prevalent conditions existed. CONCLUSIONS: Onset of any new CRM condition drove substantial increase in health care costs. Our findings indicate a clear interplay of CRM conditions and emphasize the need for better simultaneous prevention and management of these disease states to reduce the economic burden on health care systems.