Economic Burden of Anaemia
Anaemia
is common in chronic diseases, and in the elderly. It is associated with more
severe disease, and with increased mortality. It should follow that it is also
expensive. Just how expensive it is is investigated in two reports of a study
of an insured population of workers from the USA [1,2].
Study
The
basis of the analyses is from retrospective claims data from commercial and
Medicare plans, covering over two million employees. The population was
selected from only those plans with complete capture of costs, including
prescription medicines.
Anaemia
was identified from diagnostic, procedure, or drug codes, but excluding acute
anaemia. Six specific conditions with known high rates of anaemia were also
evaluated, chronic kidney disease, cancer, congestive heart failure, irritable
bowel disease, and rheumatoid arthritis, with COPD in the second but not first
analysis.
Results
First analysis [1]
During
2000 there were 2.3 million plan members with continuous coverage. In this
period there were 81,000 cases coded for anaemia, a prevalence of 3.5%. Using
2.2 million plan members with at least one year of continuous coverage over the
years 1999 to 2001, 118,000 patients with a coding of anaemia were matched with
36,000 patients without a coding for anaemia, all of whom made claims during an
average of nine months of follow up.
Despite
87% of the anaemic patients having no anaemia-specific treatment (transfusion,
erythropoietin, B12 or iron injections), there were significantly more
outpatient visits and inpatient days, laboratory tests and emergency room
visits for anaemic patients. There were, for instance, one more day in
hospital, one more outpatient visit, and three more laboratory tests per
patient associated with anaemia. On average, payments per anaemic patient were
$14,500, and for non-anaemic patients $9,500.
Second analysis [2]
Other
analyses used about 2.2 million plan members with at least one year of
continuous coverage over the years 1999 to 2001. Of these, 123,000 had at least
one of the six study conditions (5.5% of the total study population), 14,400
(0.64% of the total population) also having anaemia. In the six conditions,
average age ranged from 46 years for irritable bowel disease to 53 years for
cancer.
The
prevalence of the conditions in this population is shown in Figure 1, and the
prevalence of anaemia in the specific conditions is shown in Figure 2.
Figure 1: Prevalence of six conditions in an insured population
Figure 2: Prevalence of anaemia in the six conditions
For
these six diseases, the direct costs of care were calculated for patients with
and without anaemia, using modelling to take account of the probability of
those with anaemia having more severe disease, and incurring greater costs
because of that. Adjusting for severity halved the anaemia-associated direct
costs.
Figure
3 shows the adjusted annual anaemia-associated direct costs modelled for one
million people like those in the population studied. They were greatest for
cancer and congestive heart failure, but combined for these six conditions, the
total annual anaemia-associated cost was $110 million.
Figure 3: Anaemia-associated annual costs per million population
Comment
In
terms of the population reported in these studies, most were between 30 and 70
years, and there were somewhat more women than men. The older old were not
included because the bulk of the information was coming from an employed
population. One person in about 20 had at least one of the six conditions, and
1 in about 160 also had anaemia. Those with anaemia cost more to treat over one
year than those without anaemia, even after making allowances for the greater
disease severity that accompanies anaemia.
For
a hypothetical one million people like this, the burden of anaemia in these
conditions was $110 million. In UK terms, with 28 million people in employment,
a current exchange rate of $1.75 per £, and making an assumption that
costs here are half those in the USA, one would not get much change out of
£1 billion. That is more than in the Bandolier piggy bank, and makes
independent sensible thinking about anaemia harder, rather than sponsored
economic analysis.
References:
- AR Nissenson et al. Economic burden of anemia in an insured population. Journal of Managed Care Pharmacy 2005 11: 565-574.
- WB Ershler et al. Economic burden of patients with anemia in selected diseases. Value in Health 2005 8: 629-638.