Pacheco Alejandro, Saffie Antonio, Torres Rubén, Tortella Cristian, Llanos Cristian, Vargas Daniel, Sciaraffia Vito
Nephrology Section, Department of Medicine, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago 838-0456, Chile.
Perit Dial Int. 2007 May-Jun;27(3):359-63.
In Chile the reimbursement/patient/year for chronic peritoneal dialysis (PD) is US$14,654 and for chronic hemodialysis (HD) US$10,909. However, no study comparing global (direct plus indirect) costs has been performed in our country. Our research objective was to compare global costs and quality of life between the two therapies. Patients (n = 159) from five selected dialysis units in Chile [57 patients on PD (50 on automated PD) and 102 on standard HD (3 x 4 hours weekly)] were retrospectively studied. No patient had previously received the alternate therapy. Items analyzed were quality of life, customer satisfaction, direct and indirect costs, annual global costs, and cost/utility index. Mean age on HD was 54.14 +/- 16.01 years and on PD 49.76 +/- 18.88 years (p > 0.05). No differences in the distribution of diabetic patients between the therapies were found. Hemodialysis and PD groups did not have differences in the quality of life index, although there was better customer satisfaction with PD than with HD. Direct and indirect costs were calculated. We found significant differences in favor of PD in erythropoietin consumption (2.24 +/- 1.57 vials/week on HD and 1.35 +/- 0.85 vials/week on PD, p < 0.05) and working time (31.0 +/- 13.3 hours/week on HD and 38.5 +/- 12.2 hours/week on PD, p < 0.05). The quality life index (Health-Related SF-36 Health Survey) was 65.75 on HD and 66.88 on PD. Annual global costs were US$20,803 for HD and US$20,742 for PD. The cost/utility index was 3.16 for HD and 3.10 for PD. Patients on PD have an advantage related to erythropoietin consumption and working capacity compared with HD patients. Addition of related indirect costs to reimbursements gives a more accurate insight into treatment costs. Considering all these parameters, we did not find significant differences between HD and PD in quality life index, cost/utility index, or annual global cost in this Chilean end-stage renal disease population.
在智利，慢性腹膜透析（PD）的年人均报销费用为14,654美元，慢性血液透析（HD）为10,909美元。然而，我国尚未开展比较两种疗法总体（直接加间接）成本的研究。我们的研究目的是比较两种疗法的总体成本和生活质量。对来自智利五个选定透析单位的159例患者进行了回顾性研究[57例接受腹膜透析（50例接受自动化腹膜透析），102例接受标准血液透析（每周3次，每次4小时）]。此前所有患者均未接受过另一种疗法。分析的项目包括生活质量、客户满意度、直接和间接成本、年度总体成本以及成本/效用指数。血液透析组患者的平均年龄为54.14±16.01岁，腹膜透析组为49.76±18.88岁（p>0.05）。两种疗法的糖尿病患者分布无差异。血液透析组和腹膜透析组的生活质量指数无差异，但腹膜透析组的客户满意度高于血液透析组。计算了直接和间接成本。我们发现，腹膜透析在促红细胞生成素消耗方面具有显著优势（血液透析组每周2.24±1.57瓶，腹膜透析组每周1.35±0.85瓶，p<0.05），在工作时间方面也具有显著优势（血液透析组每周31.0±13.3小时，腹膜透析组每周38.5±12.2小时，p<0.05）。生活质量指数（健康相关的SF-36健康调查）血液透析组为65.75，腹膜透析组为66.88。血液透析的年度总体成本为20,803美元，腹膜透析为20,742美元。成本/效用指数血液透析组为3.16，腹膜透析组为3.10。与血液透析患者相比，腹膜透析患者在促红细胞生成素消耗和工作能力方面具有优势。将相关间接成本纳入报销费用能更准确地了解治疗成本。综合考虑所有这些参数，我们发现，在智利终末期肾病患者群体中，血液透析和腹膜透析在生活质量指数、成本/效用指数或年度总体成本方面无显著差异。
