Utilization and Costs of Medications Associated With CKD Mineral and Bone Disorder in Dialysis Patients Enrolled in Medicare Part D

作者：Yusuf Akeem A; Howell Benjamin L; Powers Christopher A; Peter Wendy L St^*

来源：American Journal of Kidney Diseases, 2014, 64(5): 770-780.

DOI：10.1053/j.ajkd.2014.04.014

• Chronic kidney disease (CKD)
• Medicare Part D
• medication costs
• dialysis
• mineral and bone disorder
• phosphate binders
• calcimimetics
• vitamin D analogues

Background: Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients.
Study Design: Retrospective cohort study.
Setting & Participants: Annual cohorts of dialysis patients, 2007-2010.
Predictors: Cohort year, low-income subsidy status, and dialysis provider.
Outcomes: Utilization and costs of prescription phosphate binders, oral and intravenous vitamin D analogues, and cinacalcet.
Measurements: Using logistic regression, we calculated adjusted odds of medication use for low-income subsidy versus non-low-income subsidy patients and for patients from various dialysis organizations, and we report per-member-per-month and average out-of-pocket costs.
Results: Phosphate binders (similar to 83%) and intravenous vitamin D (77.5%-79.3%) were the most commonly used CKD-MBD medications in 2007 through 2010. The adjusted odds of prescription phosphate-binder, intravenous vitamin D, and cinacalcet use were significantly higher for low-income subsidy than for non-low-income subsidy patients. Total Part D versus CKD-MBD Part D medication costs increased 22% versus 36% from 2007 to 2010. For Part D-enrolled dialysis patients, CKD-MBD medications represented similar to 50% of overall net Part D costs in 2010.
Limitations: Inability to describe utilization and costs of calcium carbonate, an over-the-counter agent not covered under Medicare Part D; inability to reliably identify prescriptions filled through a non-Part D reimbursement or payment mechanism; findings may not apply to dialysis patients without Medicare Part D benefits or with Medicare Advantage plans, or to pediatric dialysis patients; could identify only prescription drugs dispensed in the outpatient setting; inability to adjust for MBD laboratory values.
Conclusions: Part D net costs for CKD-MBD medications increased at a faster rate than costs for all Part D medications in dialysis patients despite relatively stable use within medication classes. In a bundled environment, there may be incentives to shift to generic phosphate binders and reduce cinacalcet use.

• 出版日期2014-11