Ariyaratne Thathya V, Ademi Zanfina, Duffy Stephen J, Andrianopoulos Nick, Billah Baki, Brennan Angela L, New Gishel, Black Alexander, Ajani Andrew E, Clark David J, Yan Bryan P, Yap Cheng-Hon, Reid Christopher M
Centre of Cardiovascular Research & Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.
Int J Cardiol. 2013 Oct 3;168(3):2783-90. doi: 10.1016/j.ijcard.2013.03.128. Epub 2013 May 3.
Chronic kidney disease (CKD) is a well-established risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). However, few data exists on the subsequent healthcare resource use and related incremental costs in this patient subgroup. The present study compares the rates of cardiac-related hospitalisations and the associated direct costs, post-PCI in patients with and without CKD.
Healthcare costs were estimated for 12,998 PCI patient-procedures from the Melbourne Interventional Group (MIG) registry, collected between February 2004 and October 2010. Information collected included the use of cardiovascular drugs and cardiac-related hospitalisations from those that completed 12-month follow-up. Individual patients were assigned unit costs based on published data from the National Hospital Cost Data Collection for Admissions in Victoria (2008-2009) and the Pharmaceutical Benefit Scheme (PBS) schedule (2011-2012). Bootstrap multiple linear regression was used to estimate the direct excess healthcare costs, adjusting for age and gender and relevant comorbidities.
Excess cardiac-related readmissions occurred among patients with "severe CKD or dialysis" (estimated glomerular filtration rate (eGFR): <30 ml/min/1.73 m(2); n = 330; 35%), compared to "moderate CKD" (eGFR: 30-60 ml/min/1.73 m(2); n = 2648; 28%), or the "referent CKD status" (eGFR: ≥ 60 ml/min/1.73 m(2); n = 10,020; 24%). On average, excess (95%CI) overall direct costs were significantly higher in patients with severe CKD or dialysis compared to those with referent CKD status [$AUD 2206 ($AUD 1148 to 3688)].
From the healthcare payer's perspective, PCI patients with severe CKD compared to no-CKD imposed significantly higher burden on subsequent healthcare resources. Hospitalisations accounted for the majority of these expenditures.
慢性肾脏病（CKD）是接受经皮冠状动脉介入治疗（PCI）患者发生不良事件的一个公认危险因素。然而，关于这一患者亚组后续医疗资源利用情况及相关增量成本的数据很少。本研究比较了有和没有CKD的患者PCI术后心脏相关住院率及相关直接成本。
对墨尔本介入治疗组（MIG）登记处2004年2月至2010年10月期间收集的12998例PCI患者手术的医疗成本进行了估算。收集的信息包括心血管药物的使用情况以及完成了12个月随访患者的心脏相关住院情况。根据维多利亚州国家医院入院成本数据收集（2008 - 2009年）和药品福利计划（PBS）时间表（2011 - 2012年）发布的数据，为个体患者分配单位成本。采用自助法多元线性回归来估计直接额外医疗成本，并对年龄、性别和相关合并症进行调整。
与“中度CKD”（估计肾小球滤过率（eGFR）：30 - 60 ml/min/1.73 m²；n = 2648；28%）或“对照CKD状态”（eGFR：≥ 60 ml/min/1.73 m²；n = 10020；24%）相比，“重度CKD或透析”（eGFR：<30 ml/min/1.73 m²；n = 330；35%）患者出现了更多的心脏相关再入院情况。平均而言，与对照CKD状态的患者相比，重度CKD或透析患者总的直接额外成本（95%CI）显著更高[2206澳元（1148至3688澳元）]。
从医疗支付方的角度来看，与无CKD的PCI患者相比，重度CKD患者给后续医疗资源带来的负担显著更高。住院费用占这些支出的大部分。
