Jarl Johan, Desatnik Peter, Peetz Hansson Ulrika, Prütz Karl Göran, Gerdtham Ulf-G
Health Economics, Department of Clinical Sciences-Malmö, Lund University, Lund, Sweden.
Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Clin Kidney J. 2018 Apr;11(2):283-288. doi: 10.1093/ckj/sfx088. Epub 2017 Aug 7.
The health care costs of kidney transplantation and dialysis are generally unknown. This study estimates the Swedish health care costs of kidney transplantation and dialysis over 10 years from a health care perspective.
A before-after design was used, in which the patients served as their own controls. Health care costs the year before transplantation were assumed to continue in the absence of a transplant and the cost savings was therefore calculated as the difference between the expected costs and the actual costs during the 10-year follow-up period. Factors associated with the size of the cost savings were studied using ordinary least-squares regression.
Altogether 66-79% of the expected health care costs over 10 years were avoided through kidney transplantation, resulting in a cost savings of €380 000 (2012 price-year) per patient. Savings were the highest for successful transplantations, but on average the treatment was cost-saving also for patients who returned to dialysis. No gender or age differences could be found, with the exception of a higher cost of transplantation for children and a generally higher cost for younger compared with older patients on dialysis. A negative association was also found between age at the time of transplantation and the size of the cost savings for the younger part of the sample.
Kidney transplantations have led to substantial cost savings for the Swedish health care system. An increase in donated kidneys has the potential to further reduce the cost of renal replacement therapy.
肾移植和透析的医疗费用通常未知。本研究从医疗保健角度估算了瑞典10年间肾移植和透析的医疗费用。
采用前后对照设计，患者自身作为对照。假设在没有进行移植的情况下，移植前一年的医疗费用会持续，因此成本节约额计算为10年随访期内预期成本与实际成本之间的差值。使用普通最小二乘法回归研究与成本节约规模相关的因素。
通过肾移植避免了10年间预期医疗费用的66% - 79%，每位患者节约成本38万欧元（2012年物价水平）。成功移植的节约成本最高，但平均而言，对于重新接受透析的患者，治疗也是节约成本的。未发现性别或年龄差异，但儿童移植成本较高，与老年透析患者相比，年轻透析患者的总体成本通常更高。在样本中较年轻的部分，移植时的年龄与成本节约规模之间也存在负相关。
肾移植为瑞典医疗保健系统带来了可观的成本节约。增加捐赠肾脏有可能进一步降低肾脏替代治疗的成本。
