Medical College of Wisconsin, Milwaukee, WI, USA.
Adv Chronic Kidney Dis. 2010 May;17(3):265-70. doi: 10.1053/j.ackd.2010.03.007.
Recent data suggest a large, rising burden of chronic kidney disease (CKD) in the general population and rising expenses associated with it. In 2007, CKD contributed 27.6% of costs and CKD subjects constituted 9.8% of the population. Between 1993 and 2007, overall Medicare costs nearly doubled and CKD-associated costs increased about 5-fold. The Medicare cost of end-stage renal disease has risen from $12.2 in 2000 to $20.8 billion in 2007. This review examines cost-effectiveness of prevention and treatment of CKD. Mathematical derivation of savings associated with prevention of CKD is not feasible because of dearth of data. However, examination of various factors that would affect such a hypothetical derivation indicates that prevention of CKD is cost-effective. Better data enable modeling of gross savings of slowing the progression of CKD. Data suggest that if at the beginning of the current decade, the rate of decline in GFR decreased by 10% and 30% in every patient with GFR of 60 mL/min/1.73 m(2) or less the gross direct cumulative health care savings over the next 10 years amount to $18.56 and $60.61 billion, respectively. Additional benefits accrue as a result of diminishing disability and gain in productivity. The analysis suggests that prevention and slowing progression of CKD is cost-effective.
最近的数据表明，普通人群中慢性肾脏病（CKD）的负担很大且呈上升趋势，与之相关的费用也在不断增加。2007 年，CKD 占总费用的 27.6%，CKD 患者占总人口的 9.8%。1993 年至 2007 年间，医疗保险总费用几乎翻了一番，与 CKD 相关的费用增加了约 5 倍。2000 年，终末期肾病的医疗保险费用为 12.2 美元，到 2007 年已增至 208 亿美元。本文回顾了 CKD 的预防和治疗的成本效益。由于缺乏数据，无法对 CKD 预防相关的节省进行数学推导。然而，检查影响这种假设推导的各种因素表明，预防 CKD 是具有成本效益的。更好的数据可以对减缓 CKD 进展的总节省进行建模。数据表明，如果在本世纪初，肾小球滤过率（GFR）下降速度在肾小球滤过率为 60ml/min/1.73m(2)或更低的每位患者中降低 10%和 30%，那么在未来 10 年内，直接累计医疗保健费用将分别节省 185.6 亿美元和 606.1 亿美元。由于残疾程度的降低和生产力的提高，还会产生额外的收益。该分析表明，预防和减缓 CKD 的进展具有成本效益。
