Jommi Claudio, Armeni Patrizio, Battista Margherita, di Procolo Paolo, Conte Giuseppe, Ronco Claudio, Cozzolino Mario, Costanzo Anna Maria, di Luzio Paparatti Umberto, Concas Gabriella, Remuzzi Giuseppe
Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Donegani 2, Novara, Italy.
Centre for Research in Health and Social Care Management (CERGAS), SDA School of Management Bocconi, Via Roentgen 1, Milan, Italy.
Pharmacoecon Open. 2018 Dec;2(4):459-467. doi: 10.1007/s41669-017-0062-z.
Chronic kidney disease (CKD) is an important public health problem. Most of the evidence on its costs relates to patients receiving dialysis or kidney transplants, which shows that, in these phases, CKD poses a high burden to payers. Less evidence is available on the costs of the predialytic phase.
The aim of this study was to estimate the annual cost of patients with CKD not receiving dialysis treatment, using the Italian healthcare system perspective and a prospective approach.
A 3-year observational study (December 2010-September 2014) was carried out to collect data on resource consumption for 864 patients with CKD. Costs were estimated for both patients who completed the follow-up and dropouts.
The mean annual total (healthcare) cost per patient equalled €2723 (95% confidence interval 2463.0-2983.3). Disease severity (higher CKD stage), multiple comorbidities, dropout status and belonging to the southern region are predictive of higher costs. Pharmaceuticals, hospitalisation, and outpatient services account for 71.5, 18.8 and 9.7% of total healthcare expenditure, respectively. Recent estimates of Italian costs of patients receiving dialysis are nine times the unit costs of CKD for patients estimated in this study. Unit costs at stage 5 CKD (the highest level of severity) equals 4.7 times the costs for patients at stage 1 CKD.
Despite its limitations, this study provides further evidence on the opportunity to invest in the first phases of CKD to avoid progression and an increase in healthcare costs.
慢性肾脏病（CKD）是一个重要的公共卫生问题。关于其成本的大多数证据都与接受透析或肾移植的患者有关，这表明在这些阶段，CKD给支付方带来了沉重负担。关于透析前阶段成本的证据较少。
本研究的目的是从意大利医疗保健系统的角度并采用前瞻性方法，估算未接受透析治疗的CKD患者的年度成本。
开展了一项为期3年的观察性研究（2010年12月至2014年9月），以收集864例CKD患者的资源消耗数据。对完成随访的患者和退出研究的患者都进行了成本估算。
每位患者的年均总（医疗保健）成本为2723欧元（95%置信区间2463.0 - 2983.3）。疾病严重程度（更高的CKD阶段）、多种合并症、退出研究状态以及来自南部地区是成本较高的预测因素。药品、住院和门诊服务分别占医疗保健总支出的71.5%、18.8%和9.7%。意大利近期对接受透析患者成本的估算为本研究中估算的CKD患者单位成本的9倍。CKD 5期（最高严重程度级别）的单位成本是CKD 1期患者成本的4.7倍。
尽管本研究存在局限性，但它为在CKD早期阶段进行投资以避免疾病进展和医疗成本增加的机会提供了进一步的证据。
