Cardiorenal health care costs in patients with comorbid heart failure and chronic kidney disease in England, Japan, Sweden and USA (The CaRe Study)

Background The cardiorenal diseases heart failure (HF) and chronic kidney disease (CKD) often coexist, and the presence of both conditions increases clinical risks and complicates patient management. The real-world cardiorenal healthcare costs of patients with comorbid HF and CKD are not well characterized. Purpose This analysis describes and compares healthcare costs and utilization attributable to cardiorenal complications in contemporary patients with HF only, CKD only or comorbid HF and CKD across England, Japan, Sweden and the USA. Methods This was an observational longitudinal cohort study using data from electronic health records in England (Clinical Practice Research Datalink Aurum), Japan (Medical Data Vision database), Sweden (nationwide administrative registries) and the USA (Optum’s de-identified Clinformatics® Data Mart Database). Prevalent patients with HF only, CKD only or comorbid HF and CKD on 1 January 2022 were included. HF was defined as a recorded diagnosis code. CKD was defined as either a recorded diagnosis code or ≥2 eGFR measurements ≥90 days apart, both <60 mL/min/1.73 m2. Average in-/outpatient healthcare costs and number of visits (including primary care) were cumulatively summarized per patient over a fixed 1-year follow-up. Costs were calculated from reimbursement claims for each visit, including repeat visits. Patients were censored at death or loss to follow-up; therefore, estimates reflect cumulative 1-year costs under real-world survival. Results In total, 2 752 649 patients with HF and/or CKD were included from England (n=799 828), Japan (n=615 356), Sweden (n=236 991) and the USA (n=1 100 474) (Table 1). Of these, 11% (n=91 856), 11% (n=70 100), 15% (n= 35 001) and 15% (n=164 834) had comorbid HF and CKD, respectively. Median ages were 76, 75, 77 and 78 years. Across all countries, patients with comorbid HF and CKD were older and generally had more comorbidities than those with HF or CKD alone. They also had higher healthcare costs (Figure 1A) and had a higher number of outpatient visits and hospitalizations across all countries. These costs were largely driven by hospitalization for HF and CKD (Figure 1B). Costs due to HF and CKD far exceeded those for atherosclerotic cardiovascular events (myocardial infarction, stroke and peripheral artery disease; Figure 1C). Hospitalization costs for HF and CKD closely followed the corresponding clinical risks (data not shown). Conclusion In this multinational contemporary real-world study, patients with comorbid HF and CKD demonstrated substantially higher healthcare costs and utilization compared with those with HF or CKD alone. Cardiorenal complications accounted for most of the healthcare costs, exceeding those from atherosclerotic events. These findings identify comorbid HF and CKD as a major driver of healthcare resource utilization and highlight the need for optimized cardiorenal management in this high-risk population.