Cornerstone Research Group, ON, Canada.
Curr Med Res Opin. 2013 Feb;29(2):109-15. doi: 10.1185/03007995.2012.756808. Epub 2012 Dec 20.
The avoidance of hospitalizations and the maintenance of in-center dialysis sessions in patients receiving dialysis for end-stage renal disease (ESRD) have obvious benefits to patients, dialysis providers and payers. Benefits include better continuity of care, better patient outcomes, improved quality of life, and reduced healthcare expenditures. The objective of this study was to quantify, from the perspective of a dialysis provider in the US, the potential impact of sevelamer versus calcium-based binders (CBBs) on hospitalization days and maintenance of in-center dialysis sessions among hyperphosphatemic dialysis patients.
A Microsoft Excel-based model was developed to simulate the number of missed dialysis sessions among three hypothetical cohorts of hyperphosphatemic patients treated with either sevelamer or CBBs. The cohorts were characterized by their size to represent a small, mid-size, or large dialysis organization (75, 30,000, and 120,000 patients, respectively). In any given month, a patient in the model could receive dialysis treatments within the center, experience a hospitalization, or die. Treatment-specific monthly survival rates, hospitalization rates, length of stay, and binder dosages were derived from the Dialysis Clinical Outcomes Revisited (DCOR) study. A dialysis schedule of three treatments per week was assumed. Analyses were conducted for a 1-year time horizon.
For a small dialysis center, CBBs were associated with an increased number of missed in-center dialysis treatments (447) compared to sevelamer (395). Thus, sevelamer use avoided 52 missed in-center dialysis sessions during 1 year of treatment compared to CBBs. The magnitude of sevelamer's impact on maintaining in-center dialysis treatments increased with the size of the dialysis organization; for a mid-size dialysis organization sevelamer use avoided 20,571 missed in-center dialysis sessions and for a large dialysis organization sevelamer use avoided 82,286 missed in-center dialysis sessions.
Treatment of hyperphosphatemic dialysis patients with sevelamer relative to CBBs was associated with a reduction in the number of missed in-center dialysis treatments across small, mid-size, and large dialysis organizations. This reduction could contribute to improved patient outcomes via undisrupted delivery of care within the dialysis clinic. The use of sevelamer versus CBBs could also result in an increased number of reimbursement payments to dialysis clinics and providers by avoiding missed in-center dialysis sessions due to hospitalization.
对于接受终末期肾病（ESRD）透析的患者，避免住院和维持中心透析治疗具有明显的患者、透析提供者和支付者的获益。获益包括更好的连续性护理、更好的患者结局、提高生活质量和降低医疗保健支出。本研究的目的是从美国透析提供者的角度，量化司维拉姆与钙基结合剂（CBB）相比对高磷血症透析患者住院天数和维持中心透析治疗的潜在影响。
基于 Microsoft Excel 开发了一个模型，以模拟使用司维拉姆或 CBB 治疗的三个假设高磷血症患者队列中错过的透析治疗次数。这些队列的特征是根据其大小代表一个小、中或大的透析组织（分别为 75、30000 和 120000 名患者）。在任何给定的月份，模型中的患者可以在中心接受透析治疗、住院或死亡。治疗特异性的每月生存率、住院率、住院时间和结合剂剂量均来自透析临床结果回顾性研究（DCOR）。假设每周进行三次透析治疗。分析时间范围为 1 年。
对于一个小的透析中心，与司维拉姆相比，CBB 与更多错过的中心内透析治疗次数相关（447 次相比 395 次）。因此，与 CBB 相比，在 1 年的治疗期间，司维拉姆的使用避免了 52 次中心内透析治疗的遗漏。司维拉姆对维持中心内透析治疗的影响随着透析组织规模的增加而增加；对于中型透析组织，司维拉姆的使用避免了 20571 次中心内透析治疗的遗漏，对于大型透析组织，司维拉姆的使用避免了 82286 次中心内透析治疗的遗漏。
与 CBB 相比，用司维拉姆治疗高磷血症透析患者与小、中、大透析组织中错过的中心内透析治疗次数减少相关。通过在透析诊所内不间断地提供护理，这种减少可能有助于改善患者结局。由于避免了因住院而错过的中心内透析治疗，司维拉姆的使用与 CBB 相比也可能导致透析诊所和提供者的报销支付次数增加。
