Stange P V, Sumner A T
N Engl J Med. 1978 Feb 16;298(7):372-8. doi: 10.1056/NEJM197802162980705.
To estimate the cumulative 10-year direct medical costs and life expectancy associated with different methods of treatment for end-stage renal disease, we assessed predictively three treatment transition options. It is predicted that if 1000 patients shift from facility to home dialysis for each of 10 years, life expectancy of the cohort will not be reduced, but there will be a reduction of $241 million in total costs. The same number shifting from facility dialysis to cadaveric transplantation are predicted to have a $279 to $330 million reduction in total costs but a reduction of 7 to 17 per cent in life expectancy. Shifting from home dialysis to transplantation is predicted to reduce total costs by +103 to $142 million, and life expectancy by 10 to 20 per cent. As new program policies for treatment of end-stage renal disease are developed, their effect on both costs and life expectancy needs to be considered.
为估算与终末期肾病不同治疗方法相关的10年累计直接医疗成本和预期寿命，我们对三种治疗转换方案进行了预测评估。预计如果在10年中每年有1000名患者从机构透析转为家庭透析，该队列的预期寿命不会降低，但总成本将减少2.41亿美元。预计相同数量的患者从机构透析转为尸体肾移植，总成本将减少2.79亿至3.30亿美元，但预期寿命将减少7%至17%。预计从家庭透析转为移植将使总成本减少1.03亿至1.42亿美元，预期寿命减少10%至20%。随着终末期肾病新治疗方案政策的制定，需要考虑其对成本和预期寿命的影响。
