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Background. Chronic kidney disease-associated pruritus (CKD-aP) frequently affects patients on hemodialysis and still needs an effective treatment. This retrospective observational study characterized patients on hemodialysis potentially affected or not by CKD-aP and described the use of CKD-aP-related treatments and integrated healthcare costs, from the perspective of the Italian National Health Service (INHS). Methods. Through the cross-linkage of the Italian administrative healthcare data collected in the database of Fondazione ReS (Ricerca e Salute), patients undergoing in-hospital/outpatient hemodialysis from 01/01/2015 to 12/31/2017 and for at least years were selected. Subjects with pruritus due to other causes (i.e. chronic liver disease/cirrhosis/systemic lupus erythematosus/arterial vasculitis/skin-subcutaneous tissue disease-inflammation) were excluded. CKD-aP/non-CKD-aP cohorts were created based on the presence/absence of CKD-aP-related treatment (based on common clinical practice and guidelines) supplies, characterized (demographics, comorbidities) and assessed in terms of CKD-aP-related treatments reimbursed by the INHS and mean healthcare costs per capita paid by the INHS. Results. Of 1,239 patients on hemodialysis for ≥2 years (20.2% of all hemodialysis subjects), after having applied exclusion criteria, CKD-aP were 218 (17.6%), non-CKD-aP were 1,021. Both cohorts were mostly males and elderly, but CKD-aP one was older and affected by more comorbidities. One-year before and after the index hemodialysis, of CKD-aP patients: CKD-aP-related treatments were supplied to 58.1% and 65.1%, of which >50% received chronic antihistamines (mostly cetirizine), 10% gabapentin and 1.4% received the ultraviolet light therapy. Calculated by mean, the annual cost for the healthcare reimbursed by the INHS per CKD-aP and non-CKD-aP patient was €37,065 and €35,988, respectively. Hemodialysis accounted for >60% of hospitalization expenses and >77% of outpatient care costs. Conclusions. Due to the type of information collected in Italian administrative databases, the true prevalence of CKD-aP in the Italian hemodialysis population and the costs reimbursed by the INHS for the related healthcare resulted quite underestimated. Interestingly, high-efficiency dialytic therapies performed to CKD-aP patients seemed to largely weigh on the overall mean annual cost. These findings suggest that appropriate and effective treatments for this condition might offer cost offsets. |
