Lee Helen, Manns Braden, Taub Ken, Ghali William A, Dean Stafford, Johnson David, Donaldson Cam
Department of Economics, University of Calgary, Alberta, Canada.
Am J Kidney Dis. 2002 Sep;40(3):611-22. doi: 10.1053/ajkd.2002.34924.
Care of patients with end-stage renal disease (ESRD) is important and resource intense. To enable ESRD programs to develop strategies for more cost-efficient care, an accurate estimate of the cost of caring for patients with ESRD is needed.
The objective of our study is to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and contrast differences in resources required for various dialysis modalities. One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospectively for 1 year. Detailed information on baseline patient characteristics, including comorbidity, was collected. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. We also estimated separately the cost of maintaining the dialysis access.
Overall annual cost of care for in-center, satellite, and home/self-care hemodialysis and peritoneal dialysis were US $51,252 (95% confidence interval [CI], 47,680 to 54,824), $42,057 (95% CI, 39,523 to 44,592), $29,961 (95% CI, 21,252 to 38,670), and $26,959 (95% CI, 23,500 to 30,416), respectively (P < 0.001). After adjustment for the effect of other important predictors of cost, such as comorbidity, these differences persisted. Among patients treated with hemodialysis, the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft (P < 0.001).
To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis.
终末期肾病（ESRD）患者的护理至关重要且资源消耗巨大。为使ESRD项目能够制定更具成本效益的护理策略，需要准确估算ESRD患者的护理成本。
我们研究的目的是制定一份更新且准确的透析治疗ESRD患者所需成本和资源的明细，并对比各种透析方式所需资源的差异。对166例接受透析治疗超过6个月且同意入组的患者进行了为期1年的前瞻性随访。收集了包括合并症在内的患者基线特征的详细信息。所考虑的成本包括与门诊透析护理、住院护理、门诊非透析护理和医生索赔相关的成本。我们还分别估算了维持透析通路的成本。
中心血液透析、卫星血液透析、家庭/自我护理血液透析和腹膜透析的总体年度护理成本分别为51,252美元（95%置信区间[CI]，47,680至54,824美元）、42,057美元（95%CI，39,523至44,592美元）、29,961美元（95%CI，21,252至38,670美元）和26,959美元（95%CI，23,500至30,416美元）（P<0.001）。在调整了其他重要成本预测因素（如合并症）的影响后，这些差异仍然存在。在接受血液透析治疗的患者中，与开始研究时具有功能正常的自体动静脉内瘘的患者相比，接受永久性导管或人工血管治疗的患者的血管通路相关护理成本低五倍以上（P<0.001）。
为了最大限度地提高为ESRD患者提供护理的效率，透析项目应鼓励使用家庭/自我护理血液透析和腹膜透析。
