Center for Health Technology Assessment and Outcomes Research, University of Milan, Milan, Italy.
Nephrol Dial Transplant. 2010 Mar;25(3):907-13. doi: 10.1093/ndt/gfp572. Epub 2009 Dec 14.
Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD).
An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged >or=70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean euro/patient (patient-year).
The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 euro/patient in the first, 6500 euro/patient in the second and 682 euro/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in a worst-case hypothesis.
The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.
透析可以延长患者的预期寿命，但会引起严重的临床并发症，且费用高昂。通过补充极低蛋白饮食（sVLPD）来延迟透析，可能会带来健康和经济效益。
本研究进行了一项经济评估，比较了 sVLPD 与透析在老年 CKD5 患者中的获益和成本。对先前参加过一项临床试验的 57 名年龄>70 岁、肾小球滤过率（GFR）5-7 mL/min 的患者的数据进行了分析，这些患者分为透析组（n=30）和 sVLPD 组（n=27）。采用 NHS 视角进行成本效益分析。量化了 3.2 年平均随访期间发生的直接医疗和非医疗获益和成本：免于透析的时间、透析治疗、住院、药物、实验室/仪器检查、医疗就诊和旅行的费用以及接受透析的能量消耗。使用 2007 年有效的价格/关税，并对第一年以后发生的获益和成本应用 5%的年折现率。进行了敏感性分析，以确定在不同的应用情境下，估计值可能会如何变化。结果以每个患者（患者年）的平均欧元净获益表示。
平均每位患者每年可安全推迟透析治疗 1 年，这为 NHS 带来了经济效益，第一年、第二年和第三年分别为每位患者 21180 欧元、6500 欧元和 682 欧元，即使在最坏的情况下，sVLPD 仍具有显著的净获益。
在老年 CKD5 患者中启动 sVLPD 是一种安全且有益的策略，可使这些患者获得经济资源，用于进一步的医疗保健投资。
