Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, 56127, Pisa, Italy.
Nephrology Unit, Azienda USL Toscana centro (ex-AUSL 4), piazza Ospedale 5, 59100, Prato, Italy.
Eur J Health Econ. 2017 Sep;18(7):847-858. doi: 10.1007/s10198-016-0830-1. Epub 2016 Oct 3.
This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expenses of low-protein special foods, travel, and formal and informal care. Patients' and caregivers' losses of productivity have been estimated as indirect costs using the human capital approach. Costs have been expressed in Euros (2016). Totals of 279 patients in stage 4 and 205 patients in stage 5 have been enrolled. The estimated mean annual social cost of a patient with CKD were €7422 (±€6255) for stage 4 and €8971 (±€6503) for stage 5 (p < 0.05). Direct medical costs were higher in stage 5 as compared to stage 4; direct non-medical costs and indirect costs accounted, respectively, for 41 and 5 % of the total social cost of CKD stage 4 and for 33 and 9 % of CKD stage 5. In Italy, the overall annual social cost of CKD was €1,809,552,398 representing 0.11 % of the Gross Domestic Product. Direct non-medical costs and indirect costs were weighted on the social cost of CKD almost as much as the direct medical cost. Patients, their families and the productivity system sustain the burden of the disease almost as much as the healthcare system.
这项研究旨在评估意大利透析前 4 期和 5 期慢性肾脏病（CKD）患者的平均年度社会成本及其构成。这项多中心横断面研究纳入了 2012 年至 2013 年期间 7 周内托斯卡纳地区 14 个主要肾脏病中心负责的所有成年门诊患者。直接医疗成本使用实验室检查、诊断检查、就诊、住院和药物的价格来估算。非医疗成本包括低蛋白特殊食品、旅行以及正式和非正式护理的费用。使用人力资本法估算了患者及其照顾者的生产力损失作为间接成本。成本以欧元（2016 年）表示。纳入了 4 期 279 例患者和 5 期 205 例患者。CKD 患者的估计平均年度社会成本为 4 期患者为 7422 欧元（±6255），5 期患者为 8971 欧元（±6503）（p<0.05）。与 4 期相比，5 期的直接医疗成本更高；直接非医疗成本和间接成本分别占 4 期 CKD 总社会成本的 41%和 5%，占 5 期 CKD 总社会成本的 33%和 9%。在意大利，CKD 的总年度社会成本为 1809552398 欧元，占国内生产总值的 0.11%。直接非医疗成本和间接成本在 CKD 社会成本中的权重几乎与直接医疗成本相同。患者、他们的家庭和生产力系统承担着疾病的负担，几乎与医疗保健系统一样多。
