Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba Renal Program, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Kidney Int. 2012 Feb;81(3):307-13. doi: 10.1038/ki.2011.338. Epub 2011 Oct 12.
More intensive and/or frequent hemodialysis may provide clinical benefits to patients with end-stage renal disease; however, these dialysis treatments are more convenient to the patients if provided in their homes. Here we created a standardized model, based on a systematic review of available costing literature, to determine the economic viability of providing hemodialysis in the home that arrays costs and common approaches for assessing direct medical and nonmedical costs. Our model was based on data from Australia, Canada, and the United Kingdom. The first year start-up costs for all hemodialysis modalities were higher than in subsequent years with modeled costs for conventional home hemodialysis lower than in-center hemodialysis in subsequent years. Modeled costs for frequent home hemodialysis was higher than both in-center and conventional home hemodialysis in the United Kingdom, but lower than in-center hemodialysis and higher than conventional home hemodialysis in Australia and Canada in subsequent years. The higher costs of frequent compared to conventional home hemodialysis were because of higher consumable usage due to dialysis frequency. Thus, our findings reinforce the conclusions of previous studies showing that home-based conventional and more frequent hemodialysis may provide clinical benefit at reasonable costs.
更密集和/或更频繁的血液透析可能为终末期肾病患者提供临床益处；然而，如果在患者家中进行这些透析治疗，会更加方便。在这里，我们基于现有的成本核算文献的系统回顾，创建了一个标准化模型，以确定在家庭中提供血液透析的经济可行性，该模型排列了成本和评估直接医疗和非医疗成本的常见方法。我们的模型基于来自澳大利亚、加拿大和英国的数据。所有血液透析方式的第一年启动成本都高于后续年份，模型显示常规家庭血液透析的后续年份成本低于中心血液透析。在英国，频繁家庭血液透析的模型成本高于中心血液透析和常规家庭血液透析，但在随后的年份中低于中心血液透析，高于常规家庭血液透析。与常规家庭血液透析相比，频繁家庭血液透析的成本更高，是因为透析频率更高导致消耗品使用增加。因此，我们的研究结果强化了之前研究的结论，即家庭为基础的常规和更频繁的血液透析可能以合理的成本提供临床益处。
