急性排斥反应和移植物功能降低对当代美国肾移植患者医疗费用的影响。
The implications of acute rejection and reduced allograft function on health care expenditures in contemporary US kidney transplantation.
机构信息
Saint Louis University Center for Outcomes Research, 3545 Lafayette Ave., St. Louis, MO 63104, USA.
出版信息
Transplantation. 2012 Aug 15;94(3):241-9. doi: 10.1097/TP.0b013e318255f839.
BACKGROUND
The economic ramifications of acute rejection (AR) are not well characterized in a contemporary population of kidney transplant recipients.
METHODS
Data for Medicare-insured transplant recipients in 2000 to 2007 (n=45,250) were drawn from the United States Renal Data System. AR events were ascertained from the Organ Procurement and Transplantation Network reports covering months 0 to 12 (yr1), 13 to 24 (yr2), and 25 to 36 (yr3) after transplantation. AR was subclassified as antibody (Ab)-treated AR or other management (non-Ab-treated AR). The marginal cost impact of AR events during and before a period of interest was quantified by multivariate linear regression including covariates for recipient, donor, and transplant factors.
RESULTS
Among recipients of standard criteria donor allografts, both Ab-treated AR events (yr1, $22,407; yr 2, $18,803; yr3, $13,909) and non-Ab-treated AR events (yr1, $14,122; yr2, $7852; yr3, $8234) were associated with significant increases in the cost of care. Patterns were similar among recipients of living donor and expanded criteria donor transplants. After weighting by population frequency, AR accounted for 2.3% to 3.8% of total costs incurred during 1 year of posttransplantation care. Subanalysis of recipients with yr1 estimated glomerular filtration rate (eGFR) information demonstrated markedly stronger cost variation across eGFR levels. For example, among those with non-Ab-treated AR, adjusted total yr2 costs were $22,747 with eGFR of 60 mL/min/1.73 m or higher but $43,881 with eGFR of 30 mL/min/1.73 m or lower.
CONCLUSIONS
AR is a significant contributor to individual posttransplantation costs. However, because of its low frequency, AR accounts for a small proportion of posttransplantation costs in the population. Healthcare costs in patients with AR are markedly higher among those with reduced compared with preserved allograft function.
背景
急性排斥反应（AR）的经济后果在当代肾移植受者群体中尚未得到充分描述。
方法
从美国肾脏数据系统中提取了 2000 年至 2007 年医疗保险参保移植受者的数据（n=45250）。AR 事件通过器官获取和移植网络报告确定，涵盖移植后 0 至 12 个月（第 1 年）、13 至 24 个月（第 2 年）和 25 至 36 个月（第 3 年）。将 AR 分为抗体（Ab）治疗 AR 或其他管理（非 Ab 治疗 AR）。通过包括受者、供者和移植因素的多变量线性回归，量化了在感兴趣期间和之前 AR 事件对成本的边际影响。
结果
在标准标准供体同种异体移植物受者中，Ab 治疗 AR 事件（第 1 年，$22407；第 2 年，$18803；第 3 年，$13909）和非 Ab 治疗 AR 事件（第 1 年，$14122；第 2 年，$7852；第 3 年，$8234）与护理费用的显著增加相关。在活体供者和扩大标准供体移植受者中，情况类似。通过人群频率加权后，AR 占移植后 1 年总费用的 2.3%至 3.8%。对第 1 年估计肾小球滤过率（eGFR）信息的受者进行亚分析显示，eGFR 水平之间的成本变化明显更大。例如，在非 Ab 治疗 AR 患者中，调整后的第 2 年总费用为 eGFR 为 60 mL/min/1.73 m 或更高的$22747，但 eGFR 为 30 mL/min/1.73 m 或更低的为$43881。
结论
AR 是个体移植后成本的重要组成部分。然而，由于其发生率低，AR 在人群中的移植后成本中仅占很小的比例。与移植肾功能保存的患者相比，移植肾功能降低的 AR 患者的医疗保健费用明显更高。
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