Systemic Inflammation Increases Healthcare Costs and Resource Utilization in ASCVD, CKD

New research is shedding light on stark increases in healthcare resource utilization and costs among individuals with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) who have systemic inflammation (SI).¹

The analysis of Danish national health registers revealed patients with SI had significantly greater healthcare resource utilization, including 30% more inpatient and outpatient contacts, than individuals without SI. Additionally, those with SI generated 40% increased healthcare costs compared to individuals with no SI.¹

A complex and bidirectional association exists between CKD and cardiovascular disease, including ASCVD, with each contributing to increases in the incidence and progression of the other. Both CKD and ASCVD are independently associated with an increased risk of major adverse cardiovascular events and mortality, with a proportion of this elevated risk potentially linked to SI.^1,2

“While the recognition of SI as an independent driver of cardiovascular risk is growing, it is unclear how SI influences the cost and use of healthcare services,” Martin Bødtker Mortensen, of the department of cardiology at Aarhus University Hospital and Johns Hopkins, and colleagues wrote.¹ “Such insights are important for a more comprehensive understanding of the healthcare burden associated with SI in individuals diagnosed with both ASCVD and CKD.”

To investigate the economic impact associated with SI on healthcare costs and resource utilization among individuals with concomitant ASCVD and CKD, investigators identified individuals among the total population in Denmark with ASCVD and CKD through the Danish National Patient Register based on ICD-10 codes and Nordic Classification of Surgical Procedures codes. Individuals diagnosed between January 1994 and December 2022 were identified, and those with ≥ 2 CRP tests observed < 6 months apart were included in the study. SI was defined as CRP from 2 mg/L-20 mg/L.¹

A cohort of 522,095 individuals diagnosed with ASCVD between 1994 and 2022 was identified. Within this group, 219,523 individuals had CKD stages 3–4 following 2011, identified via the Register of Laboratory Results for Research based on eGFR 15–59 mL/min/1.73 m2. After applying exclusion criteria based on comorbid conditions, the cohort was narrowed down to 84,734 individuals who had both ASCVD and CKD. Further refinement, which included ensuring an adequate number of CRP tests and excluding individuals from or before the initial year of reporting in the RLRR, resulted in a final study population of 19,159 individuals.¹

Among the cohort, 13,036 (68%) individuals met the criteria for SI. Investigators noted these patients had significantly more frequent outpatient contacts than did individuals with no SI, from 5 years before the index date until 3 years after the index date. During this period, the average person in the SI population had 6.7 more outpatient contacts than the no-SI population, with 2.3 of these excess contacts occurring after the index date.¹

Similarly, investigators pointed out individuals with SI had significantly more inpatient hospital contacts than those with no SI from 4 years before the index date to 5 years after the index date. During this period, the average individual in the SI population had 7.0 more inpatient contacts compared to those with no SI; 4.7 of these excess contacts occurred after the index date.¹

In the year following the index date, individuals with SI on average had 1.3 times the number of inpatient contacts, and 1.3 times the number of outpatient contacts, compared to those with no SI.¹

Those with SI also had significantly greater total cost of care from 5 years before the index date to 3 years after the index date. In the first 3 years following the index event, individuals with SI generated healthcare costs EUR 14,370 (16,731.48 USD; or 1.4 times) greater than individuals without SI, with the largest difference observed in the year following the index date, when the attributable cost of SI was EUR 8525 (9925.95 USD), or 1.5 times the cost for those with no SI.¹

Of note, hospital inpatient care was the primary source for the difference in costs between the 2 groups, accounting for about 85% of the total attributable cost of care during the study period.¹

“In patients diagnosed with ASCVD and CKD, SI is associated with a markedly higher cost of care and more frequent contacts with the healthcare system,” investigators concluded.¹ “Future research should explore whether treating SI could potentially reduce healthcare costs and utilization over time.”

References

1. Rudolfsen JH, Vukmirica J, Johansen P, Røder, et al. Impact of systemic inflammation on healthcare resource utilization and cost in patients with atherosclerotic cardiovascular disease and chronic kidney disease. Journal of Medical Economics. https://doi.org/10.1080/13696998.2025.2542024

2. Namvar T, Cavender MA, Miller E, et al. Perspectives in Managing Kidney Disease and Atherosclerotic Cardiovascular Disease. Cardiorenal Med. doi:10.1159/000539804