自动化腹膜透析与连续性不卧床腹膜透析的直接医疗费用比较。
Comparison of direct medical costs between automated and continuous ambulatory peritoneal dialysis.
机构信息
Unidad de Investigación Médica en Enfermedades Renales,1 Hospital de Especialidades, CMNO, and Coordinación de Salud Pública,2 Delegación Jalisco, IMSS, Guadalajara;
出版信息
Perit Dial Int. 2013 Nov-Dec;33(6):679-86. doi: 10.3747/pdi.2011.00274. Epub 2013 Apr 1.
OBJECTIVE
We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.
METHODS
Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.
RESULTS
No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component--except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.
CONCLUSIONS
The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.
目的
我们旨在估算腹膜透析（PD）的直接医疗费用（DMC），并比较持续非卧床 PD（CAPD）和自动化 PD（APD）的 DMC。此外，我们还评估了按年龄、性别和腹膜炎存在情况划分的 DMC。
方法
我们的回顾性队列分析纳入了开始 PD 的患者，计算了 2008 年的费用，并为了进行比较，对 2010 年的结果进行了更新。该分析从墨西哥社会保障研究所的角度出发，包括门诊和急诊就诊、透析程序、药物、实验室检查、住院和手术。
结果
对 41 名接受评估的患者（22 名接受 CAPD，19 名接受 APD）未观察到基线差异。2008 年和 2010 年每位 PD 患者的年度 DMC 中位数分别为 15072 美元和 16452 美元。在分析百分比分布时，各组之间的 DMC 无差异。在 APD 和 CAPD 中，主要费用与透析程序（CAPD 占 41%，APD 占 47%）和住院治疗（CAPD 占 37%，APD 占 32%）有关。APD 中的透析程序费用明显更高（p=0.001）（APD 为 7084 美元，CAPD 为 6071 美元），但总费用（APD 为 15389 美元，CAPD 为 14798 美元）和其他资源无差异。腹膜炎的存在增加了总费用（无腹膜炎患者为 16075 美元，腹膜炎患者为 14705 美元，p=0.05），但在广义线性模型分析中，DMC 不受年龄、性别、透析方式或腹膜炎的预测。对 2010 年的成本进行外推也观察到了类似的情况，每个组成部分的成本都增加了 10%至 20%，除了实验室检查增加了 52%，透析程序减少了 3%，从 2008 年开始。
结论
本研究中每位 PD 患者的年度 DMC 为 2008 年的 15072 美元和 2010 年的 16452 美元。APD 的透析程序总成本高于 CAPD，但差异无统计学意义。在 APD 和 CAPD 中，90%的费用归因于透析程序、住院治疗和药物。在多变量分析中，没有独立变量显著预测更高的 DMC。
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