Estimates of percentage point change in county-level diabetes incidence between 2004 and 2012.^†

<p>Estimates of percentage point change in county-level diabetes incidence between 2004 and 2012.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0159876#t003fn001" target="_blank">^†</a></p

Percentage point change in county-level prevalance of diagnosed diabetes among U.S. adults between 2004 and 2012.

<p>Percentage point change in county-level prevalance of diagnosed diabetes among U.S. adults between 2004 and 2012.</p

Annualized anemia treatment decision flowchart assumed in the CKD Policy Model.

<p>Annualized anemia treatment decision flowchart assumed in the CKD Policy Model.</p

Estimates of percentage point change in county-level diabetes prevalence between 2004 and 2012.^†

<p>Estimates of percentage point change in county-level diabetes prevalence between 2004 and 2012.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0159876#t002fn001" target="_blank">^†</a></p

<i>β</i>-Coefficients for changes in county-level incidence of diagnosed diabetes among adults between 2004 and 2012 for a percent point increase in incidence in 2004 by state.

<p><i>Positively significant β</i>-<i>Coefficient</i>: county-level disparity in diabetes incidence within the state widened between 2004 and 2012 (p<0.05); <i>Negatively significant β</i>-<i>Coefficient</i>: county-level disparity in diabetes incidence within the state narrowed between 2004 and 2012; <i>Not statistically significant β</i>-<i>Coefficient</i> (p<0.05); county-level disparity in diabetes incidence within the state did not change between 2004 and 2012 (p>0.05).</p

Incremental cost-effectiveness as a function of anemia treatment targets in persons with CKD stages 3–4.

<p>Incremental cost-effectiveness as a function of anemia treatment targets in persons with CKD stages 3–4.</p

The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease

<div><p>Background</p><p>Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs) for managing chronic anemia in persons with chronic kidney disease (CKD), there are differences in the recommended hemoglobin (Hb) treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3–4.</p><p>Methods and Findings</p><p>The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3–4 (i.e., not on dialysis) and anemia created from the 1999–2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios (ICERs), computed as incremental cost divided by incremental quality adjusted life years (QALYs), were assessed for Hb targets of 10 g/dl to 13 g/dl at 0.5 g/dl increments. Targeting a Hb of 10 g/dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g/dl resulted in an ICER of$32,475 compared with a Hb target of 10 g/dl. QALYs increased to 4.63 for a Hb target of 10 g/dl and to 4.75 for a target of 10.5 g/dl or 11 g/dl. Any treatment target above 11 g/dl increased medical costs and decreased QALYs.</p><p>Conclusions</p><p>In persons over age 30 with CKD stages 3–4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g/dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD.</p></div

Estimated annual percentage point changes in county-level diabetes prevalence and incidence between 2004 and 2012 for each percentage point increase in diabetes prevalence or incidence in 2004 by census region.

<p>Estimated annual percentage point changes in county-level diabetes prevalence and incidence between 2004 and 2012 for each percentage point increase in diabetes prevalence or incidence in 2004 by census region.</p

Lifetime risk of any CKD, by baseline BMI category and age.

The difference in lifetime risk of any CKD between persons age 50–64 with obesity and normal weight was statistically significant at the 1% level. No other differences were statistically significant. Abbreviations: CKD = Chronic Kidney Disease, BMI = Body Mass Index.</p

Average county-level characteristics.

<p>Average county-level characteristics.</p