Ferguson Thomas W, Whitlock Reid H, Bamforth Ryan J, Beaudry Alain, Darcel Joseph, Di Nella Michelle, Rigatto Claudio, Tangri Navdeep, Komenda Paul
Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.
Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.
Kidney Med. 2020 Nov 11;3(1):20-30.e1. doi: 10.1016/j.xkme.2020.07.011. eCollection 2021 Jan-Feb.
RATIONALE & OBJECTIVE: The kidney failure population is growing, necessitating the expansion of dialysis programs. These programs are costly and require a substantial amount of health care resources. Tools that accurately forecast resource use can aid efficient allocation. The objective of this study is to describe the development of an economic simulation model that incorporates treatment history and detailed modality transitions for patients with kidney disease using real-world data to estimate associated costs, utility, and survival by initiating modality.
Cost-utility model with microsimulation.
SETTING & POPULATION: Adult incident maintenance dialysis patients in Canada who initiated facility-based hemodialysis (HD) or home peritoneal dialysis (PD) between 2004 and 2013.
HD and PD.
Costs (related to dialysis, transplantation, infections, and hospitalizations), survival, utility, and dialysis modality mix over time.
MODEL PERSPECTIVE & TIMEFRAME: The model took the perspective of the health care payer. Patients were followed up for 10 years from initiation of dialysis. Our cost-utility analysis compared the intervention with receiving no treatment.
During a 10-year time horizon, the cost-utility ratio for all patients initiating dialysis was $103,779 per quality-adjusted life-year (QALY) in comparison to no treatment. Patients who initiated with facility-based HD were treated at a cost-utility ratio of $104,880/QALY and patients who initiated with home PD were treated at a cost-utility ratio of $83,762/QALY. During this time horizon, the total mean cost and QALYs per patient were estimated at $350,774 ± $204,704 and 3.38 ± 2.05) QALYs respectively.
The results do not include costs from the societal perspective. Rare patient trajectories were unable to be assessed.
This model demonstrates that patients who initiated dialysis with PD were treated more cost-effectively than those who initiated with HD during a 10-year time horizon.
肾衰竭患者群体不断壮大，这就需要扩大透析项目。这些项目成本高昂，需要大量医疗资源。能够准确预测资源使用情况的工具有助于实现资源的高效分配。本研究的目的是描述一种经济模拟模型的开发过程，该模型纳入了治疗史以及肾病患者详细的透析方式转换情况，利用真实世界数据通过起始透析方式来估计相关成本、效用和生存率。
微观模拟成本效用模型。
2004年至2013年间在加拿大开始接受机构血液透析（HD）或家庭腹膜透析（PD）的成年新发维持性透析患者。
HD和PD。
成本（与透析、移植、感染和住院相关）、生存率、效用以及随时间变化的透析方式组合。
该模型采用医疗保健支付方的视角。患者从开始透析起随访10年。我们的成本效用分析将干预措施与不接受治疗进行了比较。
在10年的时间范围内，与不接受治疗相比，所有开始透析的患者的成本效用比为每质量调整生命年（QALY）103,779美元。以机构HD开始透析的患者的成本效用比为104,880美元/QALY，以家庭PD开始透析的患者的成本效用比为83,762美元/QALY。在此时间范围内，每位患者的总平均成本和QALY分别估计为350,774 ± 204,704美元和3.38 ± 2.05）QALY。
结果未包括社会层面的成本。罕见的患者轨迹无法评估。
该模型表明，在10年的时间范围内，以PD开始透析的患者比以HD开始透析的患者治疗起来更具成本效益。
