建立饮食干预在肾移植受者中的成本效益模型。
Modelling the Cost-Effectiveness of Implementing a Dietary Intervention in Renal Transplant Recipients.
机构信息
Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
出版信息
Nutrients. 2021 Apr 2;13(4):1175. doi: 10.3390/nu13041175.
BACKGROUND
The Dietary Approach to Stop Hypertension (DASH) and potassium supplementation have been shown to reduce the risk of death with a functioning graft (DWFG) and renal graft failure in renal transplant recipients (RTR). Unfortunately, a key problem for patients is the adherence to these diets. The aim of this study is to evaluate the cost-effectiveness and budget impact of higher adherence to either the DASH or potassium supplementation.
METHODS
A Markov model was used to simulate the life course of 1000 RTR in the Netherlands. A societal perspective with a lifetime time horizon was used. The potential effect of improvement of dietary adherence was modelled in different scenarios. The primary outcomes are the incremental cost-effectiveness ratio (ICER) and the budget impact.
RESULTS
In the base case, improved adherence to the DASH diet saved 27,934,786 and gained 1880 quality-adjusted life years (QALYs). Improved adherence to potassium supplementation saved €1,217,803 and gained 2901 QALYs. Both resulted in dominant ICERs. The budget impact over a five-year period for the entire Dutch RTR population was €8,144,693.
CONCLUSION
Improving dietary adherence in RTR is likely to be cost-saving and highly likely to be cost-effective compared to the current standard of care in the Netherlands.
背景
通过饮食控制高血压法（DASH）和钾补充已被证明可以降低肾移植受者（RTR）的移植物功能障碍（DWFG）和肾功能衰竭的死亡风险。不幸的是，患者面临的一个关键问题是对这些饮食的坚持。本研究旨在评估提高 DASH 或钾补充剂的依从性的成本效益和预算影响。
方法
使用马尔可夫模型模拟了荷兰 1000 名 RTR 的生命过程。采用了终生时间范围的社会视角。在不同情况下，对改善饮食依从性的潜在影响进行了建模。主要结果是增量成本效益比（ICER）和预算影响。
结果
在基线情况下，改善 DASH 饮食的依从性可节省 27934786 欧元，并获得 1880 个质量调整生命年（QALY）。改善钾补充剂的依从性可节省 1217803 欧元，并获得 2901 个 QALY。两者均产生了主导的 ICER。在五年内，整个荷兰 RTR 人群的预算影响为 8144693 欧元。
结论
与荷兰目前的标准治疗相比，提高 RTR 的饮食依从性可能具有成本效益，而且很可能是具有成本效益的。
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