3-Year Healthcare Resource Consumptions of Patients With Immunoglobulin A Nephropathy in a Large Real-World Italian Database

OBJECTIVES: To assess the 3-year healthcare resource consumptions reimbursed by the Italian National Healthcare Service (SSN) for new cases of immunoglobulin A nephropathy (IgAN).

METHODS: From the Fondazione ReS (Ricerca e Salute) database (administrative healthcare data of ~5.5 million inhabitants/year), through an algorithm based on in-hospital diagnosis of glomerulonephritis and procedure of kidney biopsy in the same discharge form (index date), new cases of IgAN from 2016 to 2019 were selected. Demographics and comorbidities were described at baseline. Dispensed IgAN-related and other drugs, kidney transplantation and in-/outpatient dialysis, hospitalizations, emergency department (ED) accesses, local outpatient specialist care and related direct costs reimbursed by the SSN were assessed throughout 3 years following index date.

RESULTS: From 2016 to 2019, 292 new IgAN cases were identified (incidence: 1.25/100,000 inhabitants/year). Of them, 64% were males and 68% had ≥1 comorbidity, mostly cardio-metabolic and obstructive airway diseases. Median age was 41 (27;57) years. The annual consumption of most of the healthcare resources decreased from year 1 to year 3: from 90% to 84% of patients received ≥1 IgAN-related drug; from 100% (due to selection criteria) to 15% underwent ≥1 overnight hospitalization; from 8% to 3% underwent ≥1 day hospitalization; from 31% to 21% underwent ≥1 ED access; from 87% to 85% received ≥1 outpatient specialist service. Around 91% of patients received other drugs during follow-up. Transplantation/dialysis performances increased from 2% to 4% of patients. The per capita mean total annual cost was €7,441 in year 1 (hospitalizations accounted for 73% of total cost due to selection criteria), €3,497 in year 2, and €3,243 in year 3 (drugs accounted for 51%, mostly attributable to “other” drugs).

CONCLUSIONS: This real-world study of the direct impact on the universal-coverage SSN has shown a substantial burden of IgAN resulting not only from IgAN-related care, but also from comorbidities.