1 Swansea Centre for Health Economics, Swansea University, Swansea, UK. 2 Division of Nephrology, University Hospital of Wales, Cardiff, UK. 3 Health Economics and Outcomes Research Europe, Bristol Myers Squibb Ltd., Paris, France. 4 Address correspondence to: George Chamberlain, Swansea Centre for Health Economics, Westgate House, Womanby Street, Cardiff, CF10 1BR, UK.
Transplantation. 2014 Apr 27;97(8):854-61. doi: 10.1097/01.TP.0000438205.04348.69.
This study aims to describe the healthcare resource utilization and costs of managing renal posttransplant patients over 3 years posttransplant in nine European countries and to stratify them by year 1 glomerular filtration rate (GFR).
A retrospective observational and database analysis of renal transplant patients and a physician questionnaire study were conducted to collect recipient and donor characteristics, posttransplant events, and healthcare resource utilization related to these posttransplant events. In each country, local published costs were applied to the resource use identified. The results were stratified by the patient GFR reading at a time point 1 year after renal transplant.
The database study identified 3,181 patients who met the inclusion criteria, along with 2,818 transplants carried out in the centers surveyed by questionnaire. Total 3-year costs derived from the questionnaire analysis vary depending on local treatment practices, from a minimum of &OV0556;33,602 per patient in the Czech Republic to &OV0556;77,461 per patient in the Netherlands. Consistently across countries, estimated costs appear to decrease with improved graft functioning status (increased GFR) at 1 year. The average 3-year costs, discounting immunosuppression therapy and certain posttransplant events, per patient with a GFR greater than or equal to 60 at 1 year are estimated to be around 35% lower than those with 15≤GFR<30.
This study demonstrates that in Europe, worsening posttransplant renal function may contribute to substantive increases in resource use, with some variation across regions. Therefore, management strategies that promote renal function after transplantation have the potential to provide important resource savings.
本研究旨在描述欧洲九个国家的肾移植后 3 年以上患者的医疗资源利用情况和成本，并按第 1 年肾小球滤过率（GFR）对其进行分层。
对肾移植患者进行回顾性观察性数据库分析和医生问卷调查研究，以收集患者和供者特征、移植后事件以及与这些移植后事件相关的医疗资源利用情况。在每个国家，均采用当地公布的成本来计算资源利用情况。结果按患者肾移植后 1 年时的 GFR 读数进行分层。
数据库研究确定了 3181 名符合纳入标准的患者，以及通过问卷调查对中心进行调查的 2818 例移植。来自问卷调查分析的 3 年总成本因当地治疗实践而异，从捷克共和国每位患者最低 33602 欧元到荷兰每位患者 77461 欧元不等。在所有国家中，估计成本似乎随移植物功能状态（GFR 增加）的改善而降低。1 年时 GFR 大于或等于 60 的每位患者的平均 3 年成本（扣除免疫抑制治疗和某些移植后事件）估计比 GFR 为 15≤GFR<30 的患者低约 35%。
本研究表明，在欧洲，移植后肾功能恶化可能导致资源利用的实质性增加，且各地区存在一定差异。因此，促进移植后肾功能的管理策略有可能节省重要资源。
