Gilardino Ramiro E, González-Pier Eduardo, Brabata Claudia
Global Networks Latin America, International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, USA.
Centre for Global Development, Washington, DC, USA.
Value Health Reg Issues. 2018 Dec;17:115-118. doi: 10.1016/j.vhri.2018.04.001. Epub 2018 May 22.
End-stage renal disease, the last and most severe stage of chronic kidney disease, represents a major and rising concern for countries in Latin America, driven in large part by aging populations and the near-epidemic rises in diabetes, obesity, and hypertension. This places a great clinical, economic, and social burden on the region's health systems. During the ISPOR 6th Latin America Conference held in Sao Paulo, Brazil, in September 2017, an educational forum debated on value-based decision making in the treatment of end-stage renal disease in Latin America. We summarize the current state and how to build strategies and implement actions to move to a more patient-centered, outcomes-based approach for renal care in the region, taken from the discussions in the conference and also from a literature review. Models of renal care used in Ontario (Canada), Colombia, and a Chilean hospital stress the importance of empowering and supporting patients and their families, allowing for a better coordination between primary care providers and specialists, providing financial incentives to health units, and establishing an entity that holds insurers and providers accountable for health outcomes and costs of treatment. The study uses the framework of value-based health care for the evaluation of different dialysis options-peritoneal dialysis, hemodialysis, home dialysis, and so forth-and calls for the countries to adopt an integrated care model. We emphasize that countries in Latin America need to recognize the chronic kidney disease challenge and develop health systems and efficient renal care models to be able to reduce the burden of the disease.
终末期肾病是慢性肾病的最后也是最严重阶段，在很大程度上受人口老龄化以及糖尿病、肥胖症和高血压近乎流行的增长趋势影响，已成为拉丁美洲各国日益严重的重大关切问题。这给该地区的卫生系统带来了巨大的临床、经济和社会负担。在2017年9月于巴西圣保罗举行的国际药效经济学和结果研究协会（ISPOR）第六届拉丁美洲会议期间，一个教育论坛就拉丁美洲终末期肾病治疗中基于价值的决策展开了辩论。我们根据会议讨论内容以及文献综述，总结了该地区当前的状况以及如何制定战略并采取行动，转向以患者为中心、基于结果的肾脏护理方法。加拿大安大略省、哥伦比亚以及一家智利医院所采用的肾脏护理模式强调赋予患者及其家庭权力并给予支持、实现初级保健提供者与专科医生之间更好协调、为卫生单位提供经济激励以及设立一个让保险公司和提供者对健康结果及治疗费用负责的实体的重要性。该研究运用基于价值的医疗保健框架来评估不同的透析选择——腹膜透析、血液透析、家庭透析等等——并呼吁各国采用综合护理模式。我们强调，拉丁美洲各国需要认识到慢性肾病带来的挑战，并发展卫生系统和高效的肾脏护理模式，以便能够减轻该疾病的负担。
