Psychosocial determinants of healthcare use costs in kidney transplant recipients

Psychosocial factors frequently occur in kidney transplant recipients (KTRs), leading to behavioral alterations and reduced therapeutic adherence. However, the burden of psychosocial disorders on costs for KTRs is unknown. Aim of the study is to identify predictors of healthcare costs due to hospital admissions and emergency department accesses in KTRs. This is a longitudinal observational study conducted in KTRs aged >18 years, excluding patients with insufficient level of autonomy and cognitive disorder. KTRs underwent psychosocial assessment by two interviews, namely Mini International Neuropsychiatric Interview 6.0 (MINI 6.0) and Diagnostic Criteria for Psychosomatic Research Interview (DCPR) and by Edmonton Symptom Assessment System Revised (ESAS-R), a self-administrated questionnaire. Sociodemographic data and healthcare costs for hospital admissions and emergency department accesses were collected in the 2016-2021 period. Psychosocial determinants were 1) ESAS-R psychological and physical score; 2) symptomatic clusters determined by DCPR (illness behavior cluster, somatization cluster and personological cluster); 3) ICD-diagnosis of adjustment disorder, anxiety disorder and mood disorder. A multivariate regression model was used to test the association between psychosocial determinants and total healthcare costs. 134 KTRs were enrolled, of whom 90 (67%) males with a mean age 56 years. Preliminary analysis of healthcare costs highlighted higher healthcare costs are correlated with worse outcomes and death (p<0.001). Somatization clusters (p=0.020), mood disorder (p<0.001) and transplant vintage (p=0.013) were positively associated with costs due to hospital admission; as well as mood disorder (p=0.004) and dialysis vintage (p<0.001) with costs due to emergency department accesses. In conclusion, this study showed somatization and mood disorders could predict costs for hospital admissions and emergency department accesses and be risk factors for poor outcome, including death, in KTRs.