Tajima A, Ueda D, Hirai M, Morinaga S, Sudoko H, Yamaguchi Y, Mitsuhashi T, Nakano M, Kanbayashi T, Ushiyama T
Department of Urology, School of Medicine, Hamamatsu University.
Hinyokika Kiyo. 1987 Oct;33(10):1536-41.
We studied the medical costs of hemodialysis, CAPD and renal transplantation in our patients with chronic renal failure. The cost per patient averaged 660,000 yen for hemodialysis (760,000 yen for CAPD) in the first month when dialysis was started and 460,000 yen for routine maintenance hemodialysis (240,000 yen for CAPD). There was a difference in cost between recipients treated with conventional immunosuppressants (conventional group) and those receiving cyclosporine (Cs-group). That is, the estimated average cost for the conventional group was 3,800,000 in the first month after kidney grafting and at 60,000 yen in the subsequent months when the patient is cared for at the outpatient clinic; that of Cs-group was at 2,710,000 yen and 170,000 yen. This difference is due to the high cost of cyclosporine. The cumulative cost of maintenance hemodialysis is on a constant linear increase. Recently, clinical results of renal transplantation have improved markedly. Furthermore, our analysis of questionnaires to patients shows that renal transplantation is far superior to hemodialysis on the aspect of the quality of life. Thus, renal transplantation should be promoted further, and then the combined treatment of a low dose of cyclosporine and other immunosuppressants might be recommended to reduce the cost of cyclosporine.
我们研究了慢性肾衰竭患者进行血液透析、持续性非卧床腹膜透析（CAPD）和肾移植的医疗费用。透析开始后的第一个月，血液透析每位患者的平均费用为660,000日元（CAPD为760,000日元），常规维持性血液透析为460,000日元（CAPD为240,000日元）。接受传统免疫抑制剂治疗的受者（传统组）和接受环孢素治疗的受者（环孢素组）在费用上存在差异。也就是说，传统组在肾移植后的第一个月估计平均费用为3,800,000日元，在患者在门诊接受治疗的后续月份为60,000日元；环孢素组分别为2,710,000日元和170,000日元。这种差异是由于环孢素成本高昂。维持性血液透析的累积费用呈持续线性增长。最近，肾移植的临床结果有了显著改善。此外，我们对患者问卷的分析表明，肾移植在生活质量方面远优于血液透析。因此，应进一步推广肾移植，然后可能建议联合使用低剂量环孢素和其他免疫抑制剂以降低环孢素的成本。
