Bongiovanni Isabelle, Couillerot-Peyrondet Anne-Line, Sambuc Cléa, Dantony Emmanuelle, Elsensohn Mad-Hélénie, Sainsaulieu Yoël, Ecochard René, Couchoud Cécile
Service évaluation économique et santé publique, Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 Saint-Denis-la-Plaine cedex, France.
Service évaluation économique et santé publique, Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 Saint-Denis-la-Plaine cedex, France.
Nephrol Ther. 2016 Apr;12(2):104-15. doi: 10.1016/j.nephro.2015.10.004. Epub 2016 Feb 22.
End-stage renal disease is a chronic state that may continue for many years before death. Patients may receive various modalities of renal replacement therapy that vary over time, which we describe as a treatment trajectory. The French health insurance system pays dialysis facilities and professionals various fixed fees according to the dialysis modalities they provide; fees are highest for hospital-based haemodialysis care, which treats around 58% of all dialysis patients. As in other European countries, a variety of dialysis modalities are used in France, and their weight and distribution differ from region to region. This study hypothesizes that some patients currently treated in hospital-based haemodialysis could be treated with another RRT modality without any increase in mortality risk. The aim of this study was to propose new care strategies so as to evaluate the medico-economic impact of replacing some hospital-based HD care by various other modalities for French health insurance. Care strategies were modelled using a statistical tool that predicts course and trajectories of a hypothetical cohort of news patients over a 15-year period. The results confirmed that the development of kidney transplantation in six sub-cohorts (according to age and diabetes status) is an efficient strategy, compared to all evaluated strategies. Strategies considering joint development of peritoneal dialysis and hospital-based haemodialysis are efficient for patients over 45 years but their feasibility has to be evaluated. Other alternative strategies also need to be considered because they are as effective and less costly than the current care practices.
终末期肾病是一种慢性疾病状态，在死亡前可能持续多年。患者可能会接受多种不同的肾脏替代治疗方式，且这些方式会随时间变化，我们将其描述为治疗轨迹。法国医疗保险系统根据透析机构和专业人员提供的透析方式支付各种固定费用；基于医院的血液透析护理费用最高，约58%的透析患者接受这种治疗。与其他欧洲国家一样，法国使用多种透析方式，其比重和分布因地区而异。本研究假设，目前在基于医院的血液透析治疗的一些患者可以采用另一种肾脏替代治疗方式，而不会增加死亡风险。本研究的目的是提出新的护理策略，以评估用其他多种方式替代部分基于医院的血液透析护理对法国医疗保险的医疗经济影响。使用一种统计工具对护理策略进行建模，该工具可预测一个假设的新患者队列在15年期间的病程和轨迹。结果证实，与所有评估策略相比，六个亚组（根据年龄和糖尿病状况）中肾移植的发展是一种有效的策略。考虑腹膜透析和基于医院的血液透析联合发展的策略对45岁以上患者有效，但必须评估其可行性。还需要考虑其他替代策略，因为它们与当前的护理实践一样有效且成本更低。
