Mennini Francesco S, Russo Simone, Marcellusi Andrea, Quintaliani Giuseppe, Fouque Denis
Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy; Department of Accounting and Finance, Kingston University, London, United Kingdom.
Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy; Department of Occupational Medicine, INAIL, Formerly ISPESL, Rome, Italy.
J Ren Nutr. 2014 Sep;24(5):313-21. doi: 10.1053/j.jrn.2014.05.003.
The most recent literature has shown extensively that a low-protein diet in patients with chronic kidney disease (CKD) delays the natural progression of end-stage renal disease and the necessary treatment of chronic dialysis. The aim of this study was to estimate the cost-effectiveness of a very low-protein diet compared with a moderate low-protein diet.
Markov model.
The study was conducted from the perspective of the Italian National Health Service.
Patients with CKD stages 4 and 5. Seven hundred and two patients were considered, and half were treated with a very low-protein diet and the other half with a moderate low-protein diet.
The Markov model estimates the costs and the quality-adjusted life years (QALYs) associated with a very low-protein diet versus a moderate low-protein diet for patients with CKD Stages 4 and 5. The transition probability was estimated on data from 7 studies, which determined the efficacy of very low-protein diets in delaying the need to start maintenance dialysis. Utilities and cost were estimated from literature review and projected for the lifespan considered in the model. The annual cost of dialysis per patient was approximately €34,072. The cost of a very low-protein diet was €1,440 per patient per year in the Lazio region (conservative assumptions). Probabilistic and deterministic sensitivity analyses were performed.
QALY, cost of treatment, incremental cost-effectiveness ratio.
The model estimates that a very low-protein diet should be more effective. Dietary treatment improved 0.09 QALYs after 2 years, 0.16 after 3 years, 0.36 after 5 years, and up to 0.93 incremental QALYs after the first 10 years. After 2 years, the model estimated increment cost in favor of the most restrictive dietary treatment of €826, €2,146, €5,203, and €10,375 for 2, 3, 5, and 10 years of follow-up respectively.
The results of these simulations indicate that the treatment of CKD patients with a very low-protein diet is cost-effective relative to a moderate low-protein diet in an Italian setting. Further studies should test this model in other countries with different dialysis costs and dietary support.
最新文献广泛表明，慢性肾脏病（CKD）患者采用低蛋白饮食可延缓终末期肾病的自然进展及慢性透析的必要治疗。本研究旨在评估极低蛋白饮食与适度低蛋白饮食相比的成本效益。
马尔可夫模型。
本研究从意大利国家卫生服务的角度进行。
CKD 4期和5期患者。共纳入702例患者，其中一半接受极低蛋白饮食治疗，另一半接受适度低蛋白饮食治疗。
马尔可夫模型估计了CKD 4期和5期患者采用极低蛋白饮食与适度低蛋白饮食相关的成本和质量调整生命年（QALY）。转移概率根据7项研究的数据估算，这些研究确定了极低蛋白饮食在延迟开始维持性透析需求方面的疗效。效用和成本通过文献综述估算，并针对模型中考虑的寿命进行预测。每位患者每年的透析费用约为34,072欧元。在拉齐奥地区，每位患者每年极低蛋白饮食的成本为1,440欧元（保守假设）。进行了概率和确定性敏感性分析。
QALY、治疗成本、增量成本效益比。
模型估计极低蛋白饮食应更有效。饮食治疗在2年后改善了0.09个QALY，3年后改善了0.16个，5年后改善了0.36个，在前10年中增量QALY高达0.93个。2年后，模型估计，对于2年、3年、5年和10年的随访，分别有利于最严格饮食治疗的增量成本为826欧元、2,146欧元、5,203欧元和10,375欧元。
这些模拟结果表明，在意大利的环境中，用极低蛋白饮食治疗CKD患者相对于适度低蛋白饮食具有成本效益。进一步的研究应在透析成本和饮食支持不同的其他国家测试该模型。
