Croxson B E, Ashton T
Department of Economics, University of Auckland.
N Z Med J. 1990 Apr 25;103(888):171-4.
An economic evaluation of continuous ambulatory peritoneal dialysis (CAPD), home haemodialysis, incentre haemodialysis and transplantation was carried out using cost effectiveness analysis to evaluate the cost per life year saved. The probability that a person with end stage renal failure would change treatment modalities was used to calculate an average five year treatment profile. The present value of the cost per life year saved (expressed in 1988 $NZ) was $35,270 for incentre dialysis, $28,175 for home haemodialysis, $26,390 for CAPD at Middlemore Hospital, $25,395 for CAPD at Auckland Hospital and $18.463 for transplantation. This ranking was unchanged after various sensitivity analyses. This apparent ranking of the cost effectiveness of the different modalities cannot, however, be used to support a decrease in haemodialysis in favour of an increase in transplants and CAPD until marginal cost factors have been studied. It must also be recognised that social and medical characteristics define which treatments are appropriate for any patient so that the different modalities are not perfect substitutes for each other.
采用成本效益分析方法对持续性非卧床腹膜透析（CAPD）、家庭血液透析、中心血液透析和肾移植进行了经济学评估，以评估每挽救一个生命年的成本。利用终末期肾衰竭患者改变治疗方式的概率来计算平均五年治疗情况。每挽救一个生命年的成本现值（以1988年新西兰元表示），中心血液透析为35,270新西兰元，家庭血液透析为28,175新西兰元，Middlemore医院的CAPD为26,390新西兰元，奥克兰医院的CAPD为25,395新西兰元，肾移植为18,463新西兰元。经过各种敏感性分析后，这一排名没有变化。然而，在研究边际成本因素之前，不同治疗方式成本效益的这种明显排名不能用于支持减少血液透析而增加肾移植和CAPD。还必须认识到，社会和医学特征决定了哪种治疗方法适合任何患者，因此不同的治疗方式并非彼此的完美替代品。
