The longitudinal cost of end-stage renal disease in persons with diabetes in the United States

The objective of this study was to estimate the longitudinal direct medical costs associated with end-stage renal disease (ESRD) in persons with diabetes. Data from the United States Renal Data System for 1997 and 1998 were analysed to estimate monthly Medicare payments for services provided for the 24-month period beginning 12 months prior to the date of first ESRD service. A total of 14,254 patients with diabetes and ESRD were identified for analysis. Medicare payments averaged US$450 per person (95% CI: US$401, US$499) 12 months prior to initiation of dialysis. In the month before initiation of dialysis, Medicare payments increased to an average of US$5,210 (95% CI: US$5,090, US$5,330) per patient. Medicare payments further increased to an average of US$12,531 per person (95% CI: US$12,368, US$12,695) for the first month of dialysis-a 28-fold increase compared with 12 months earlier. Not only are healthcare costs significant in the year following initiation of dialysis, but the healthcare costs increase substantially in the year prior to initiation of dialysis in persons with diabetes.