Kroeker Andrew, Clark William F, Heidenheim A Paul, Kuenzig Louise, Leitch Rosemary, Meyette Michael, Muirhead Norman, Ryan Heather, Welch Randy, White Sharon, Lindsay Robert M
Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Am J Kidney Dis. 2003 Jul;42(1 Suppl):49-55. doi: 10.1016/s0272-6386(03)00538-9.
Although several studies have shown that simulated annual direct health care costs are substantially lower for patients undergoing more frequent hemodialysis (HD), there is limited information about the economics of daily HD and nocturnal HD.
The London Daily/Nocturnal Hemodialysis Study compared the economics of short daily HD (n = 10), long nocturnal HD (n = 12), and conventional thrice-weekly HD (n = 22) in patients over 18 months. A retrospective analysis of patients' conventional HD costs during the 12 months before study entry was conducted to measure the change in cost after switching to quotidian HD.
As the data show, annual costs (in Canadian dollars) for daily HD are substantially lower than for both nocturnal HD and conventional HD: approximately 67,300 Can dollars, 74,400 Can dollars, and 72,700 Can dollars per patient, respectively. Moreover, marginal changes in operating cost per patient year were - 9,800 Can dollars, -17,400 Can dollars, and +3,100 Can dollars for the daily HD, nocturnal HD, and conventional HD groups. Because of the increase in number of treatments, treatment supply costs per patient for the daily HD and nocturnal HD study groups were approximately twice those for conventional HD patients. However, average costs for consults, hospitalization days, emergency room visits, and laboratory tests for quotidian HD patients tended to decline after study entry. The major cost saving in home quotidian HD derived from the reduction in direct nursing time, excluding patient training. Total annualized cost per quality-adjusted life-year for the daily HD and nocturnal HD groups were 85,442 Can dollars and 120,903 Can dollars, which represented a marginal change of - 15,090 Can dollars and - 21,651 Can dollars, respectively, reflecting both improved quality of life and reduced costs for quotidian HD patients.
Substantial clinical benefits of home quotidian HD, combined with the economic advantage shown by this study, clearly justify its expansion.
尽管多项研究表明，接受更频繁血液透析（HD）的患者的模拟年度直接医疗保健成本大幅降低，但关于每日HD和夜间HD的经济学信息有限。
伦敦每日/夜间血液透析研究比较了18个月以上患者的短程每日HD（n = 10）、长程夜间HD（n = 12）和传统每周三次HD（n = 22）的经济学情况。对患者入组前12个月的传统HD成本进行回顾性分析，以衡量转换为每日HD后的成本变化。
如数据所示，每日HD的年度成本（以加元计）大幅低于夜间HD和传统HD：每位患者分别约为67,300加元、74,400加元和72,700加元。此外，每日HD、夜间HD和传统HD组每位患者每年的运营成本边际变化分别为-9,800加元、-17,400加元和+3,100加元。由于治疗次数增加，每日HD和夜间HD研究组每位患者的治疗供应成本约为传统HD患者的两倍。然而，每日HD患者入组后的咨询、住院天数、急诊室就诊和实验室检查的平均成本趋于下降。家庭每日HD的主要成本节省来自直接护理时间的减少，不包括患者培训。每日HD和夜间HD组每质量调整生命年的总年化成本分别为85,442加元和120,903加元，分别代表边际变化-15,090加元和-21,651加元，这反映了每日HD患者生活质量的改善和成本的降低。
家庭每日HD的显著临床益处，结合本研究显示的经济优势，显然证明了其推广的合理性。
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