(40) Retrospective analysis of cardiovascular, renal, and metabolic conditions in the Medicare population using 100% FFS claims data

Background: : Cardiovascular, renal, and metabolic (CRM) conditions impose a substantial burden on the US Medicare population. Leveraging national FFS claims can inform real-world prevalence, costs, and care patterns of CRM.

Objective: : To assess the prevalence, healthcare resource utilization (HCRU), and economic impact of CRM conditions in the Medicare FFS population from 2016 to 2023.

Methods: : This retrospective cohort study used de-identified 100% Medicare FFS claims data (Parts A, B, and D) from 2016 to 2023. Beneficiaries aged 65+ were included if diagnosed with atherosclerotic cardiovascular disease or heart failure (C), chronic kidney disease (R), and/or type 2 diabetes (M). Patients were categorized into mutually exclusive health states: C only, R only, M only; dual combinations (C+R, C+M, R+M); and triple multimorbidity (C+R+M). Annual prevalence, HCRU, and Medicare costs (2023 USD), were reported overall and by condition type.

Results: : Over 40 million beneficiaries with CRM diagnoses were included, with 20 million unique patients in 2022 and 19.6 million unique patients in 2023. CRM prevalence increased from 2016-2023, with the largest growth among multimorbid patients, particularly those in the C+R+M and C+M groups. In 2023, among patients with any CRM diagnosis, health states prevalences were as follows: C only (31.7%), M only (18.9%), C+M (15.8%), C+R+M (11.8%), C+R (9.9%), R only (7.2%), and R+M (4.8%). Medicare expenditures were significantly higher for patients with ≥2 CRM conditions. Median total all-cause annualized spending was $3,995 overall and $5,572 for C+R+M. Among utilizers, inpatient institutional care reached a median of $30,759 overall and $43,895 for C+R+M. Other high-cost services among utilizers included SNF care ($22,738 overall; $31,617 for C+R+M), outpatient ($6,440; $10,823), home health ($7,221; $9,016), and hospice ($43,039; $32,804). CRM-specific spending in 2023, defined by claims with a CRM-related principal diagnosis, were a median $743 across all patients and $1,364 for C+R+M. From 2016 to 2023, CRM-specific spending rose 18% in real terms, with the steepest growth in C+M patients (27%).

Conclusions: : Prevalence of CRM conditions is increasing and associated with high utilization and spending across care settings in the Medicare FFS population. These results also underscore the disproportionate cost burden associated with CRM multimorbidity and its importance when developing population health strategy, targeted interventions, and benefit design in Medicare.

Sponsorship:: Boehringer Ingelheim Pharmaceuticals, Inc