Lefebvre Patrick, Duh Mei Sheng, Buteau Sharon, Bookhart Brahim, Mody Samir H
Groupe d'Analyse, Montréal, Québec, Canada.
J Am Soc Nephrol. 2006 Dec;17(12):3497-502. doi: 10.1681/ASN.2006030289. Epub 2006 Nov 2.
The objective of this study was to quantify the incremental medical costs that are associated with untreated anemia among elderly patients with predialysis chronic kidney disease (CKD). An analysis of claims and laboratory data between January 1999 and February 2005 was conducted. Inclusion criteria were age >/=65 yr, two or more hemoglobin readings, one or more claims for CKD, and two or more GFR values of <60 ml/min per 1.73 m(2) (stages 3 to 5 CKD). Patients were excluded when they had cancer or lupus, had received organ transplantation, or were treated for anemia. An open-cohort design was used to classify patients' observation periods into anemia and nonanemia. Both univariate and multivariate analyses were conducted to compare periods of anemia and nonanemia for average monthly medical costs; the latter was adjusted for age, gender, GFR, diabetes, hypertension, liver cirrhosis, coronary artery disease, myocardial infarction, and left ventricular hypertrophy. A subset analysis of patients with moderate CKD (stage 3) was conducted. A total of 2001 patients were identified. Untreated anemia was associated with a significant increase in medical costs, with an unadjusted incremental monthly cost of $1089 (P < 0.0001) and a cost ratio of 1.8:1 relative to nonanemia. After controlling for covariates, untreated anemia remained significantly associated with a cost increase (adjusted incremental monthly cost $503; cost ratio 1.4:1; P < 0.0001). Similar significant cost burden was observed in the subset of patients with moderate CKD. The retrospective observational design may be more susceptible to bias than a randomized, controlled trial. This large study, which was based on real-life practice data, demonstrated that untreated anemia in elderly patients with predialysis CKD was associated with a significant increase in medical costs.
本研究的目的是量化未治疗的贫血在患有透析前慢性肾脏病（CKD）的老年患者中所产生的额外医疗费用。对1999年1月至2005年2月期间的索赔和实验室数据进行了分析。纳入标准为年龄≥65岁、有两次或更多次血红蛋白读数、有一次或更多次CKD索赔，以及两次或更多次肾小球滤过率（GFR）值<60 ml/（min·1.73 m²）（CKD 3至5期）。患有癌症或狼疮、接受过器官移植或接受过贫血治疗的患者被排除。采用开放队列设计将患者的观察期分为贫血期和非贫血期。进行单变量和多变量分析以比较贫血期和非贫血期的平均每月医疗费用；多变量分析对年龄、性别、GFR、糖尿病、高血压、肝硬化、冠状动脉疾病、心肌梗死和左心室肥厚进行了校正。对中度CKD（3期）患者进行了亚组分析。共确定了2001例患者。未治疗的贫血与医疗费用显著增加相关，未校正的每月增量费用为1089美元（P<0.0001），相对于非贫血的费用比为1.8:1。在控制协变量后，未治疗的贫血仍与费用增加显著相关（校正后的每月增量费用为503美元；费用比为1.4:1；P<0.0001）。在中度CKD患者亚组中也观察到了类似的显著费用负担。回顾性观察设计可能比随机对照试验更容易产生偏倚。这项基于实际临床数据的大型研究表明，患有透析前CKD的老年患者中未治疗的贫血与医疗费用显著增加相关。
