Liu Jing, Hutton David W, Gu Yonghong, Hu Yao, Li Yi, Ma Liang, Zeng Xiaoxi, Fu Ping
Division of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
Perit Dial Int. 2020 Mar;40(2):193-201. doi: 10.1177/0896860819893812. Epub 2020 Jan 17.
End-stage renal disease has been imposing a heavy economic burden on public health; however, few studies have been performed on the cost-effectiveness of dialysis modalities. We aim to estimate the cost-effectiveness of different dialysis modalities in China.
Cost-effectiveness analyses were performed using Markov models based on published data of hemodialysis (HD) and peritoneal dialysis (PD) modalities in China. Sensitivity analyses were conducted to identify key variables influencing the results.
Over a 10-year time horizon, the base-case cost-effectiveness analysis indicated that PD-first absolutely dominated the HD-first option by gaining 0.13 more quality-adjusted life years (QALYs) and costing RMB ¥81,081 less. When using reported mortality of HD and PD from the United States, the PD-first option still dominated HD-first with higher QALYs and lower costs. Sensitivity analyses revealed that the results were more sensitive to the direct cost of HD, utility of HD, utility of PD, direct cost of PD, PD mortality, and HD mortality, while less sensitive to the indirect costs and transition probabilities. The HD utility needed to be at least 0.148 higher than PD utility for HD to be cost-effective. PD was about 72% likely to be considered cost-effective compared with HD, regardless of the willingness-to-pay for QALYs.
PD appears to be more cost-effective than HD in China, and the major influential factors on the cost-effectiveness are the direct costs of HD, utility of HD, utility of PD, direct costs of PD, PD mortality, and HD mortality.
终末期肾病给公共卫生带来了沉重的经济负担；然而，关于透析方式成本效益的研究较少。我们旨在评估中国不同透析方式的成本效益。
基于中国血液透析（HD）和腹膜透析（PD）方式的已发表数据，使用马尔可夫模型进行成本效益分析。进行敏感性分析以确定影响结果的关键变量。
在10年的时间范围内，基础病例成本效益分析表明，优先选择腹膜透析绝对优于优先选择血液透析，多获得0.13个质量调整生命年（QALY），且成本降低81,081元人民币。当使用美国报道的血液透析和腹膜透析死亡率时，优先选择腹膜透析仍然以更高的QALY和更低的成本优于优先选择血液透析。敏感性分析显示，结果对血液透析的直接成本、血液透析的效用、腹膜透析的效用、腹膜透析的直接成本、腹膜透析死亡率和血液透析死亡率更为敏感，而对间接成本和转移概率较不敏感。血液透析的效用需要比腹膜透析的效用至少高0.148才能具有成本效益。无论对QALY的支付意愿如何，与血液透析相比，腹膜透析被认为具有成本效益的可能性约为72%。
在中国，腹膜透析似乎比血液透析更具成本效益，对成本效益的主要影响因素是血液透析的直接成本、血液透析的效用、腹膜透析的效用、腹膜透析的直接成本、腹膜透析死亡率和血液透析死亡率。
