Mahdavi-Mazdeh Mitra, Zamani Mozafar, Zamyadi Mahnaz, Rajolani Hamid, Tajbakhsh Keyvan, Heidary Rouchi Alireza, Aghighi Mahammad, Mahdavi Azita
Department of Nephrology, Tehran University, Tehran, Iran.
Hemodial Int. 2008 Oct;12(4):492-8. doi: 10.1111/j.1542-4758.2008.00313.x.
The purpose of this study was to assess the health service cost of hemodialysis (HD) delivered at hospitals in Iran as a developing country with a well-defined program of renal replacement therapy. A cost analysis was performed from the viewpoint of the 2 hospitals, with 3 shifts and full chairs, on current practice for dialysis maintenance. Cost and patient data were collected in 2006 and from April 1 to May 31, 2007, respectively. A total of 22,464 HD sessions were performed and 247 patients were studied during the study period. The reference year for the value of USD for different mentioned costs was 2006. Health care sector costs associated with each HD session were estimated at US$78.87. Most of the total maintenance expenditure was made up of medical supplies (36.19%), with dialyzers as the major cost driver. Staff salaries represented 17% of the cost and fixed direct capital costs accounted for 21.4%. Of the family members, 32.4% accompanied their patients. The mean cost for transportation of patients and accompanied person was US$3.15 +/- 2.83 and US$1.5 +/- 0.29, respectively. These findings are important in the light of limited available resources coupled with the increasing prevalence of kidney failure. A major attempt should also be made to increase peritoneal dialysis coverage as in some centers we cannot keep all chairs full, especially in some vast areas. It is highly recommended to place initial focus on strategies and treatments that slow disease progression, to postpone renal replacement therapy to save resources.
本研究的目的是评估伊朗作为一个拥有明确肾脏替代治疗计划的发展中国家，医院提供血液透析（HD）的医疗服务成本。从两家拥有三班制和满负荷透析椅的医院的角度，对当前透析维持治疗的实践进行了成本分析。成本和患者数据分别于2006年以及2007年4月1日至5月31日收集。在研究期间共进行了22464次血液透析治疗，并对247名患者进行了研究。不同提及成本的美元价值的基准年为2006年。每次血液透析治疗相关的医疗保健部门成本估计为78.87美元。总维护支出的大部分由医疗用品构成（36.19%），其中透析器是主要成本驱动因素。员工工资占成本的17%，固定直接资本成本占21.4%。在家庭成员中，32.4%的人陪伴他们的患者。患者和陪同人员的平均交通成本分别为3.15美元±2.83美元和1.5美元±0.29美元。鉴于可用资源有限以及肾衰竭患病率不断上升，这些发现具有重要意义。还应做出重大努力，增加腹膜透析的覆盖范围，因为在一些中心我们无法使所有透析椅满负荷运转，特别是在一些广阔地区。强烈建议首先关注减缓疾病进展的策略和治疗方法，推迟肾脏替代治疗以节省资源。
