Health Economics and Outcome Research, Baxter Latin America, Bogotá, DC, Colombia.
Second City Outcomes Research LLC, Oak Park, IL, USA.
Perit Dial Int. 2020 Jul;40(4):377-383. doi: 10.1177/0896860819896880. Epub 2020 Jan 13.
The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia.
Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results.
The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving.
The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.
自动化腹膜透析（APD）的益处已得到证实，但患者对治疗的依从性仍是一个关注点。远程患者监测（RPM）计划是一个潜在的解决方案；然而，其成本影响尚未得到充分确立。本研究从支付方的角度，对哥伦比亚一项新型 RPM 计划的预期净成本和临床后果进行了建模。
采用马尔可夫模型对接受和未接受 RPM 的 APD 患者的成本和临床结果进行预测。临床数据直接从肾护理服务数据中估算，或从文献中获取。透析成本根据国家收费标准估算。住院费用取自最近的哥伦比亚研究。该模型预测了总体直接成本和多项临床结果。还进行了确定性和概率敏感性分析（DSA 和 PSA），以描述结果的不确定性。
模型预测，在 100 名 APD 患者队列中实施每月成本为 35 美元的 RPM 计划，在 1 年内将节省 121,233 美元。该模型还预测将有 31 个月免于并发症，27 次住院次数减少，518 天住院天数减少，6 次腹膜炎发作减少。在 DSA 中，结果对住院率和住院天数最为敏感，但节省成本是稳健的。PSA 发现，RPM 计划有 91%的可能性具有成本效益。
模型结果表明，RPM 在 APD 患者中具有成本效益，这需要通过严格的前瞻性成本分析来验证。
