Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
University Hospitals Birmingham, Birmingham, United Kingdom.
PLoS One. 2018 Nov 26;13(11):e0207960. doi: 10.1371/journal.pone.0207960. eCollection 2018.
Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Individuals with more severe CKD had lower HRQoL compared to those with better kidney function. Compared to those with normal/low normal kidney function and stage 1 CKD, those with stage 2, stage 3 with albuminuria and stage 4/5 CKD experienced a decrement of 0.11, 0.18 and 0.28 in their utility index, respectively. Applying the UK reimbursement threshold for a QALY, the monetised lifetime burden of reduced HRQoL due to stage 2, stage 3 with albuminuria and stage 4/5 CKD were £103,734; £83,399; £125,335 in males and £143,582; £70,288; £203,804 in females, respectively. Utilizing the predicted prevalence of CKD among individuals with diabetes mellitus, the economic burden of CKD per million of individuals with diabetes is forecasted at approximately £11.4 billion in 2025. In conclusion, CKD has a strong adverse impact on HRQoL in multiple domains. The estimated economic burden of CKD among individuals with diabetes mellitus in the UK is projected to rise markedly over time.
慢性肾脏病（CKD）影响了多达 15%的成年人口，并且与包括糖尿病在内的其他非传染性慢性疾病密切相关。然而，基于人群的 CKD 与健康相关生活质量（HRQoL）之间的关系及其带来的经济成本的相关信息十分有限。我们利用 2010 年英格兰健康调查的代表性样本，对这种关系进行了调查。采用多变量 Tobit 模型来检验 HRQoL 与 CKD 严重程度之间的关系。将 HRQoL 转换为质量调整生命年（QALY）指标，具体做法是结合生活质量的下降以及与疾病严重程度增加相关的预期寿命减少来计算。使用英国 3 万英镑报销阈值，对 QALY 进行贴现和货币化调整。然后，使用预测的患病率，结合 2025 年之前患有糖尿病的个体的 CKD 来估计与 CKD 相关的 HRQoL 负担。与肾功能较好的个体相比，CKD 较严重的个体的 HRQoL 较低。与肾功能正常/轻度正常和 CKD1 期患者相比，CKD2 期、伴有白蛋白尿的 CKD3 期和 CKD4/5 期患者的效用指数分别下降了 0.11、0.18 和 0.28。如果按照英国 QALY 报销阈值，因 CKD2 期、伴有白蛋白尿的 CKD3 期和 CKD4/5 期导致的 QALY 降低的终身货币化负担，男性患者分别为 103734 英镑、83399 英镑和 125335 英镑，女性患者分别为 143582 英镑、70288 英镑和 203804 英镑。利用预测的糖尿病患者 CKD 患病率，预计 2025 年英国每 100 万糖尿病患者的 CKD 经济负担约为 114 亿英镑。总之，CKD 对多个领域的 HRQoL 有严重的负面影响。预计随着时间的推移，英国糖尿病患者 CKD 的经济负担将显著增加。
