Cost of illness of hyponatremia in the United States

Audra Boscoe, Clark Paramore, Joseph G Verbalis, Audra Boscoe, Clark Paramore, Joseph G Verbalis

Abstract

Background: Hyponatremia is a disorder of fluid and electrolyte balance characterized by a relative excess of body water relative to body sodium content. It is the most common electrolyte disorder encountered in clinical medicine and is associated with negative outcomes in many chronic diseases. However, there is limited information in the literature about health care resource use and costs attributable to the effects of the condition. The purpose of this analysis was to estimate the annual cost of illness of hyponatremia in the United States.

Methods: The study utilized a prevalence-based cost of illness framework that incorporated data from publicly available databases, published literature and a consensus panel of expert physicians. Panel members provided information on: classification of hyponatremia patients, treatment settings for hyponatremia (i.e., hospital, emergency room, doctor's office), and health care resource use associated with the diagnosis and treatment of hyponatremia. Low and high prevalence scenarios were estimated and utilized in a spreadsheet-based cost of illness model. Costs were assigned to units of resources and summarized across treatment settings.

Results: The prevalence estimate for hyponatremia ranged from 3.2 million to 6.1 million persons in the U.S. on an annual basis. Approximately 1% of patients were classified as having acute and symptomatic hyponatremia, 4% acute and asymptomatic, 15%-20% chronic and symptomatic, and 75-80% chronic and asymptomatic. Of patients treated for hyponatremia, 55%-63% are initially treated as inpatients, 25% are initially treated in the emergency room, and 13%-20% are treated solely in the office setting. The direct costs of treating hyponatremia in the U.S. on an annual basis were estimated to range between $1.6 billion and $3.6 billion.

Conclusion: Treatment of hyponatremia represents a significant healthcare burden in the U.S. Newer therapies that may reduce the burden of hyponatremia in the inpatient setting could minimize the costs associated with this condition.

References

    1. Schrier RW. Manual of Nephrology. Philadelphia, Lippincott Williams & Wilkins; 2000. The patient with hyponatremia or hypernatremia; pp. 21–36.
    1. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581–1589. doi: 10.1056/NEJM200005253422107.
    1. Janicic N, Verbalis JG. Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am. 2003;32:459–81, vii. doi: 10.1016/S0889-8529(03)00004-5.
    1. DeVita MV, Gardenswartz MH, Konecky A, Zabetakis PM. Incidence and etiology of hyponatremia in an intensive care unit. Clin Nephrol. 1990;34:163–166.
    1. Kleinfeld M, Casimir M, Borra S. Hyponatremia as observed in a chronic disease facility. J Am Geriatr Soc. 1979;27:156–161.
    1. Miller M, Morley JE, Rubenstein LZ. Hyponatremia in a nursing home population. J Am Geriatr Soc. 1995;43:1410–1413.
    1. Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169–172. doi: 10.1016/j.cccn.2003.08.001.
    1. Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation. 1986;73:257–267.
    1. Panciroli C, Galloni G, Oddone A, Marangoni E, Masa A, Cominesi WR, Caizzi V, Pezzi C, Belletti S, Cornalba C, Orlandi M. Prognostic value of hyponatremia in patients with severe chronic heart failure. Angiology. 1990;41:631–638.
    1. Chin MH, Goldman L. Correlates of major complications or death in patients admitted to the hospital with congestive heart failure. Arch Intern Med. 1996;156:1814–1820. doi: 10.1001/archinte.156.16.1814.
    1. Terzian C, Frye EB, Piotrowski ZH. Admission hyponatremia in the elderly: factors influencing prognosis. J Gen Intern Med. 1994;9:89–91.
    1. Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102:164–168.
    1. Krumholz HM, Chen YT, Bradford WD, Cerese J. Variations in and correlates of length of stay in academic hospitals among patients with heart failure resulting from systolic dysfunction. Am J Manag Care. 1999;5:715–723.
    1. Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992;2:1–4.
    1. Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 2nd. Oxford, Oxford Medical Publications; 1997.
    1. Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984;74:979–983.
    1. Sniezek JA. A comparison group of techniques for judgmental forecasting by groups with common information. Group Organization Stud. 1990;15:5–19.
    1. Murray MI, Halpern MT, Leppik IE. Cost of refractory epilepsy in adults in the USA. Epilepsy Res. 1996;23:139–148. doi: 10.1016/0920-1211(95)00090-9.
    1. Plumb JM, Guest JF. Annual cost of erectile dysfunction to UK Society. Pharmacoeconomics. 1999;16:699–709. doi: 10.2165/00019053-199916060-00008.
    1. Mazzuca SA, Cohen SJ. Scoring patient management problems: external validation of expert consensus. Eval Health Prof. 1982;5:210–217.
    1. Sanmarco ME, Brooks SH, Blankenhorn DH. Reproducibility of a consensus panel in the interpretation of coronary angiograms. Am Heart J. 1978;96:430–437. doi: 10.1016/0002-8703(78)90151-5.
    1. Severens JL, Habraken JM, Duivenvoorden S, Frederiks CM. The cost of illness of pressure ulcers in The Netherlands. Adv Skin Wound Care. 2002;15:72–77. doi: 10.1097/00129334-200203000-00008.
    1. Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost & Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database [online].
    1. Tierney WM, Martin DK, Greenlee MC, Zerbe RL, McDonald CJ. The prognosis of hyponatremia at hospital admission. J Gen Intern Med. 1986;1:380–385.
    1. Centers for Medicare and Medicaid Services (CMS) Data on hospitals' cost-to-charge ratios [online].
    1. U.S. Bureau of Labor Statistics Consumer price index [online]
    1. MAG Mutual Healthcare Solutions Inc. Physicians' fee and coding guide (a comprehensive fee & coding reference). Augusta (GA), HealthCare Consultants of America Inc.; 2004.
    1. Centers for Medicare and Medicaid Services (CMS) Data on Ambulatory Payment Classification System.
    1. Paramore LC, Ciuryla V, Ciesla G, Liu L. Economic impact of respiratory syncytial virus-related illness in the US: an analysis of national databases. Pharmacoeconomics. 2004;22:275–284. doi: 10.2165/00019053-200422050-00001.
    1. National Institutes of Health (NIH) Information for disease and conditions. Appendix to: Disease-specific estimates of direct and indirect costs of illness and NIH support. , National Institutes of Health, Public Health Service, Department of Health and Human Services; 1997.
    1. Wilson L, Brown JS, Shin GP, Luc KO, Subak LL. Annual direct cost of urinary incontinence. Obstet Gynecol. 2001;98:398–406. doi: 10.1016/S0029-7844(01)01464-8.
    1. American Heart Association (AHA) Heart disease and stroke statistics - 2004 update [online].
    1. Movig KL, Leufkens HG, Lenderink AW, Egberts AC. Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia. J Clin Epidemiol. 2003;56:530–535. doi: 10.1016/S0895-4356(03)00006-4.
    1. Natkunam A, Shek CC, Swaminathan R. Hyponatremia in a hospital population. J Med. 1991;22:83–96.
    1. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, Marteau T. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2:i–iv, 1-88.
    1. Cohen P, Cohen J. The clinician's illusion. Arch Gen Psychiatry. 1984;41:1178–1182.
    1. Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest. 1993;103:601–606.
    1. Fraser CL, Arieff AI. Epidemiology, pathophysiology, and management of hyponatremic encephalopathy. Am J Med. 1997;102:67–77. doi: 10.1016/S0002-9343(96)00274-4.
    1. Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med. 1957;23:529–542. doi: 10.1016/0002-9343(57)90224-3.
    1. Schrier RW. Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (1) N Engl J Med. 1988;319:1065–1072.
    1. Flear CT, Gill GV, Burn J. Hyponatraemia: mechanisms and management. Lancet. 1981;2:26–31. doi: 10.1016/S0140-6736(81)90261-0.
    1. Westwater ML, Davies JC. Follow up of 742 tuberculosis patients. Follow up at eighteen months of 742 tuberculosis patients notified in midlands and south-eastern province in six months in 1964. Cent Afr J Med. 1967;13:175–176.
    1. Samadi AR, Wahed MA, Islam MR, Ahmed SM. Consequences of hyponatraemia and hypernatraemia in children with acute diarrhoea in Bangladesh. Br Med J (Clin Res Ed) 1983;286:671–673.
    1. Bennani SL, Abouqal R, Zeggwagh AA, Madani N, Abidi K, Zekraoui A, Kerkeb O. [Incidence, causes and prognostic factors of hyponatremia in intensive care] Rev Med Interne. 2003;24:224–229.
    1. Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S. Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc. 2003;95:335–343.
    1. Francis GS, Benedict C, Johnstone DE, Kirlin PC, Nicklas J, Liang CS, Kubo SH, Rudin-Toretsky E, Yusuf S. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD) Circulation. 1990;82:1724–1729.
    1. Verbalis JG. The syndrome of inappropriate antidiuretic hormone secretion and other hypoosmolar disorders. In: Schrier RW, editor. Diseases of the Kidney. Philadelphia, Lippincott Williams and Wilkins; 2001. pp. 2511–2548.
    1. Hirshberg B, Ben-Yehuda A. The syndrome of inappropriate antidiuretic hormone secretion in the elderly. Am J Med. 1997;103:270–273. doi: 10.1016/S0002-9343(97)00250-7.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe