Psychiatric Disease and Medical Financial Burden Among Commercially Insured Adult Kidney Transplant Recipients in the United States.

Although psychiatric disorders after kidney transplantation (KT) are associated with adverse outcomes, the associated risk factors, treatment patterns, and financial burden remain poorly characterized. We sought to address these gaps by characterizing psychiatric diagnoses, their treatment, and patient financial liability in the first year following KT.Adult KT recipients (KTRs) from 2006 to 2021 were identified using IQVIA PharMetrics Plus for Academics, a large population-based commercial insurance claims database. Psychiatric diagnoses were defined using International Classification of Diseases-Ninth Revision (ICD9)/Tenth Revision (ICD10) codes, and patient characteristics and total financial liability within the first year post-transplant were compared between KTRs with and without a psychiatric diagnosis. Regression analyses identified factors associated with post-KT psychiatric diagnoses.Among 2148 KTRs, 291 (13.5%) had a prevalent psychiatric diagnosis within 1 year post-KT; 102 (35.1%) were incident diagnoses. Prevalence varied by KTR transplant era, with 17.3% of the 2014-2017 cohort having an ICD9/10 psychiatric diagnosis code in the year following KT. The strongest factor associated with post-KT psychiatric diagnosis was a pre-existing psychiatric diagnosis (aOR 21.68), while incident diagnoses were significantly associated with hospital length of stay >1 week (aOR 2.10). Early post-KT complications were also associated with subsequent psychiatric diagnosis (aOR 1.96; 95% CI 1.23-3.07). Only half of those with a psychiatric diagnosis (N = 148/291) had a claim for treatment (i.e., pharmacotherapy and/or psychotherapy). The median total patient liability for 1 year of post-KT care was $2100 (IQR $700-8200), and not significantly different between those with and without psychiatric diagnoses (p = 0.29).Despite higher healthcare utilization in KTRs with psychiatric diagnoses, median total financial liability was not significantly different between groups. Clinicians should be attentive to risk factors for psychiatric complications and consider protocols to screen symptoms among high-risk individuals.

Duke Scholars

Author Yue Jiang Statistical Science