Klebe Bernhard, Irving Jean, Stevens Paul E, O'Donoghue Donal J, de Lusignan Simon, Cooley Roger, Hobbs Helen, Lamb Edmund J, John Ian, Middleton Rachel, New John, Farmer Christopher K T
Department of Renal Medicine, Kent and Canterbury Hospital, East Kent Hospitals NHS Trust, and Computing Laboratory, University of Kent, Canterbury, Kent CT1 3NG, UK.
Nephrol Dial Transplant. 2007 Sep;22(9):2504-12. doi: 10.1093/ndt/gfm248. Epub 2007 Jun 5.
Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases.
We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed.
In the first year, a practice of 10,000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline>or=5 ml/min/1.73 m2/year, 1.11 with haemoglobin<11 g/dl and 1.67 with blood pressure>150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was euro 6111; and euro 7836 for nephrology referral. Total costs of euro 17 133 in the first year were increased to euro 29,790 through the effect of creatinine calibration.
CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10,000 patients managed according to guidelines.
慢性肾脏病（CKD）是一个重大的公共卫生问题。在英国，已制定相关指南以促进病例识别和管理。我们的目的是估算针对新确诊的CKD病例实施这些指南的年度成本。
我们使用一个用Java程序创建的数据库对早期肾脏干预计算机评估新机会（NEOERICA）数据库进行查询，该程序用于将CKD指南重新编译为基于规则的决策树。这将在1年期间记录有血清肌酐的所有患者分类为需要更多检查或转诊的患者。对遵循指南进行了为期12个月的成本分析。
在第一年，一个拥有10000名患者的医疗机构将识别出147.5例3 - 5期CKD患者，这些患者超出了已确诊的患者。所有4 - 5期CKD病例都需要转诊至肾脏病科。在3期CKD患者（143.85例）中，126.27例病情稳定的患者需要更多检查。以下情况需要转诊：14.8例估计肾小球滤过率下降≥5 ml/min/1.73 m²/年，1.11例血红蛋白<11 g/dl，1.67例在使用三种抗高血压药物治疗的情况下血压>150/90。对病情稳定的3期CKD患者进行检查的预计每个医疗机构成本为6111欧元；肾脏病科转诊成本为7836欧元。由于肌酐校准的影响，第一年的总成本17133欧元增加到了29790欧元。
实施CKD指南导致肾脏病科转诊和额外检查显著增加。按照指南管理的每10000名患者中，若有一人将透析需求推迟1年，这些成本便可得到弥补。
