Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720, BA, Bilthoven, The Netherlands.
Erasmus School of Health Policy & Management (ESHPM), Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
BMC Nephrol. 2021 Oct 16;22(1):341. doi: 10.1186/s12882-021-02548-y.
Healthcare costs related to ESRD are well-described, but broader societal costs of ESRD are less known. This study aimed to estimate patient and family costs, including informal care costs and out-of-pocket costs, and costs due to productivity loss related to ESRD, for patients receiving dialysis and living with a kidney transplant, using a bottom-up approach.
A total of 655 patients were asked to complete a digital questionnaire consisting of two standardised instruments (iMCQ and iPCQ) from November 2016 through January 2017. We applied a retrospective bottom-up cost estimation by combining data from the questionnaire with unit prices from the Dutch costing manual.
Our study sample consisted of 230 patients, of which 165 were kidney transplant recipients and 65 received dialysis. The total annual non-healthcare related costs were estimated at €8284 (SD: €14,266) for transplant recipients and €23,488 (SD: €39,434) for dialysis patients. Costs due to productivity loss contributed most to the total non-healthcare costs (66% for transplant recipients and 65% for dialysis patients), followed by informal care costs (26% resp. 29%) and out-of-pocket costs, such as medication and travel expenses (8% resp. 6%).
By exposing patient, family and productivity costs, our study revealed that dialysis and transplantation are not only costly within the healthcare system, but also incur high non-healthcare costs (18-23% resp. 35% of the total societal costs). It is important to reveal these types of non-healthcare costs in order to understand the full burden of ESRD for society and the potential impact of new therapies.
终末期肾病（ESRD）相关的医疗保健费用已有详细描述，但对 ESRD 的更广泛的社会成本知之甚少。本研究旨在采用自下而上的方法，估算接受透析和肾移植患者的患者和家庭成本，包括非正式护理成本和自付费用，以及与 ESRD 相关的生产力损失成本。
共有 655 名患者被要求在 2016 年 11 月至 2017 年 1 月期间填写一份数字问卷，该问卷由两个标准化工具（iMCQ 和 iPCQ）组成。我们通过将问卷数据与荷兰成本核算手册中的单价相结合，应用回溯性自下而上成本估算。
我们的研究样本由 230 名患者组成，其中 165 名是肾移植受者，65 名接受透析治疗。移植受者的非医疗相关年度总成本估计为 8284 欧元（SD：14266 欧元），透析患者为 23488 欧元（SD：39434 欧元）。生产力损失导致的成本对非医疗保健总成本的贡献最大（移植受者占 66%，透析患者占 65%），其次是非正式护理成本（26% 对 29%）和自付费用，如药物和旅行费用（8% 对 6%）。
通过揭示患者、家庭和生产力成本，我们的研究表明，透析和移植不仅在医疗保健系统内成本高昂，而且还会产生高昂的非医疗保健成本（占总成本的 18-23%，分别占 35%）。揭示这些类型的非医疗保健成本对于了解 ESRD 给社会带来的全部负担以及新疗法的潜在影响非常重要。
