Pike Eva, Hamidi Vida, Ringerike Tove, Wisloff Torbjorn, Klemp Marianne
Norwegian Institute of Public Health, Oslo, Norway.
Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacology, University of Oslo, Norway.
J Clin Med Res. 2017 Feb;9(2):104-116. doi: 10.14740/jocmr2817w. Epub 2016 Dec 31.
Patients with end-stage renal disease (ESRD) are in need of renal replacement therapy as dialysis and/or transplantation. The prevalence of ESRD and, thus, the need for dialysis are constantly growing. The dialysis modalities are either peritoneal performed at home or hemodialysis (HD) performed in-center (hospital or satellite) or home. We examined effectiveness and cost-effectiveness of HD performed at different locations (hospital, satellite, and home) and peritoneal dialysis (PD) at home in the Norwegian setting.
We conducted a systematic review for patients above 18 years with end-stage renal failure requiring dialysis in several databases and performed several meta-analyses of existing literature. Mortality and major complications that required were our main clinical outcomes. The quality of the evidence for each outcome was evaluated using GRADE. Cost-effectiveness was assessed by developing a probabilistic Markov model. The analysis was carried out from a societal perspective, and effects were expressed in quality-adjusted life-years. Uncertainties in the base-case parameter values were explored with a probabilistic sensitivity analysis. Scenario analyses were conducted by increasing the proportion of patients receiving PD with a corresponding reduction in HD patients in-center both for Norway and Europian Union. We assumed an annual growth rate of 4% in the number of dialysis patients, and a relative distribution between PD and HD in-center of 30% and 70%, respectively.
From a societal perspective and over a 5-year time horizon, PD was the most cost-effective dialysis alternative. We found no significant difference in mortality between peritoneal and HD modalities. Our scenario analyses showed that a shift toward more patients on PD (as a first choice) with a corresponding reduction in HD in-center gave a saving over a 5-year period of 32 and 10,623 million EURO, respectively, for Norway and the European Union.
PD was the most cost-effective dialysis alternative and was comparable with HD regarding efficacy outcomes. There are significant saving potentials if more end-stage renal patients are started on PD instead of HD.
终末期肾病（ESRD）患者需要通过透析和/或移植进行肾脏替代治疗。ESRD的患病率，以及因此对透析的需求在持续增长。透析方式包括在家进行的腹膜透析或在中心（医院或卫星中心）或在家进行的血液透析（HD）。我们在挪威的背景下，研究了在不同地点（医院、卫星中心和家中）进行的HD以及在家进行的腹膜透析（PD）的有效性和成本效益。
我们在多个数据库中对18岁以上需要透析的终末期肾衰竭患者进行了系统评价，并对现有文献进行了多项荟萃分析。死亡率和所需的主要并发症是我们的主要临床结局。使用GRADE评估每个结局的证据质量。通过建立概率马尔可夫模型评估成本效益。分析从社会角度进行，效果以质量调整生命年表示。通过概率敏感性分析探索基础病例参数值的不确定性。通过增加接受PD的患者比例，相应减少挪威和欧盟在中心接受HD的患者比例进行情景分析。我们假设透析患者数量的年增长率为4%，PD和在中心HD的相对分布分别为30%和70%。
从社会角度和5年的时间跨度来看，PD是最具成本效益的透析选择。我们发现腹膜透析和HD方式在死亡率上没有显著差异。我们的情景分析表明，向更多接受PD（作为首选）的患者转变，相应减少在中心HD的患者，在5年期间分别为挪威和欧盟节省了32亿和106.23亿欧元。
PD是最具成本效益的透析选择，在疗效结局方面与HD相当。如果更多的终末期肾病患者开始接受PD而非HD，存在显著的节省潜力。
