Tediosi F, Bertolini G, Parazzini F, Mecca G, Garattini L
Mario Negri Institute for Pharmacological Research, Ranica, Italy.
Health Serv Manage Res. 2001 Feb;14(1):9-17. doi: 10.1177/095148480101400102.
This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. Highflux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.
本研究分析了意大利国家医疗服务体系（NHS）中透析的管理与成本。同时，还基于现有文献介绍了有关疗效及健康相关生活质量（HRQOL）的信息。透析方式之间的临床差异似乎与其对特定患者群体的适用性有关。疗效率相似，唯一的差异在于并发症和健康相关生活质量。传统血液透析（THD）可由意大利患者在透析中心或医院进行。高通量血液透析（HFHD）通常仅在医院进行。腹膜透析（PD）通常在家中进行。根据完全成本法，对意大利透析中心和医院的样本进行了成本分析。正如预期的那样，高通量血液透析比传统血液透析和腹膜透析更昂贵，但不同的高通量血液透析方式之间未出现明显差异。透析中心的传统血液透析方式比在医院成本更低。自动化腹膜透析（APD）比持续性非卧床腹膜透析（CAPD）贵得多（几乎两倍），而持续性非卧床腹膜透析是绝对成本最低的方法。本研究证实透析成本高昂，且很难评估不同方法的成本效益。尽管本研究存在局限性，但它应为地方医疗管理者提供足够的分析信息，以便更合理地分配用于透析服务的财政资源。
