家庭夜间血液透析与传统中心血液透析的生活质量和成本效用
The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.
作者信息
McFarlane Philip A, Bayoumi Ahmed M, Pierratos Andreas, Redelmeier Donald A
机构信息
Department of Medicine, Home Dialysis Clinic, Inner City Health Research Unit, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
Kidney Int. 2003 Sep;64(3):1004-11. doi: 10.1046/j.1523-1755.2003.00157.x.
BACKGROUND
Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.
METHODS
Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.
RESULTS
Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about 10,000 dollars lower for home nocturnal hemodialysis (55,139 dollars +/- 7651 dollars for home nocturnal hemodialysis vs. 66,367 dollars +/- 17,502 dollars for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 +/- 0.23 vs. 0.53 +/- 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was 71,443 dollars/quality-adjusted life-year (QALY), while for in-center hemodialysis it was 125,845 dollars/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -45,932 dollars. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of 50,000 dollars. The net monetary benefit of home nocturnal hemodialysis ranged from 11,227 dollars to 35,669 dollars.
CONCLUSION
Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.
背景
家庭夜间血液透析是一种强化血液透析形式，患者每周约6个晚上在家中进行约7小时的治疗。与中心常规血液透析相比，家庭夜间血液透析已被证明可改善生理参数并降低医疗保健成本；然而，其对生活质量和成本效益的影响尚不清楚。我们假设进行家庭夜间血液透析的个体比中心血液透析患者具有更高的生活质量和更好的成本效益。
方法
来自一家没有家庭血液透析项目的医院的家庭夜间血液透析患者和一组人口统计学特征相似的中心血液透析患者接受了计算机辅助访谈，以通过标准博弈法评估他们对当前健康状况的效用评分。
结果
对19名中心血液透析患者和24名家庭夜间血液透析患者进行了访谈。家庭夜间血液透析的年均成本比中心血液透析低约10,000美元（家庭夜间血液透析为55,139美元±7651美元，中心血液透析为66,367美元±17,502美元，P = 0.03）。家庭夜间血液透析与比中心血液透析更高的效用评分相关（0.77±0.23对0.53±0.35，P = 0.03）。家庭夜间血液透析的成本效益为71,443美元/质量调整生命年（QALY），而中心血液透析为125,845美元/QALY。家庭夜间血液透析是主要策略，增量成本效益比（ICER）为-45,932美元。ICER的95%置信区间以及ICER的2500次自助抽样迭代均低于成本效益上限50,000美元。家庭夜间血液透析的净货币效益在11,227美元至35,669美元之间。
结论
与中心血液透析相比，家庭夜间血液透析与更高的生活质量和更好的成本效益相关。
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