Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho chi Minh City, Vietnam; Nephrology and Hemodialysis Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Department of Dialysis, Cho Ray Hospital, Hochiminh City, Vietnam.
Clin Ther. 2023 Jul;45(7):649-654. doi: 10.1016/j.clinthera.2023.05.008. Epub 2023 Jun 24.
The aim of this study was to estimate the cost-effectiveness of a very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids compared with a conventional low-protein diet (LPD) in Vietnam.
The study was conducted from payer (base case), patient, and societal perspectives. A Markov model simulated costs and quality-adjusted life-years (QALYs) for patients with chronic kidney disease stage 4 or 5 (CKD4+) who were followed up during their lifetimes. Patients received a VLPD (0.3- to 0.4-g/kg/d diet) supplemented with ketoanalogues (5 kg/d [1 tablet]) versus LPD (0.6 g/kg/d, mixed proteins). In each model cycle, patient transitions among the health states-CKD4+ (nondialysis), dialysis, and death-were based on transition probabilities taken from the published literature. The time horizon covered the cohort's lifetime. Utilities and costs were estimated from literature review and projected for the lifespan considered in the model. Probabilistic and deterministic sensitivity analyses were performed.
The ketoanalogue-supplemented VLPD increased survival and QALYs compared with the LPD. From a payer's perspective, total cost of care in Vietnam was ₫216,854,268 (€8684/$9242) per patient with LPD versus ₫200,928,819 (€8046/$8563) per patient with a supplemented VLPD (sVLPD) (difference, -₫15,925,449 [-€638/-$679]). From a patient's perspective, total cost of care in Vietnam was ₫217,872,043 (€8724/$9285) per patient with LPD versus ₫116,015,672 (€4646/$4944) per patient with sVLPD (difference, -₫101,856,371 [-€4,079/ -$4341]). From a societal perspective, total cost of care in Vietnam was ₫434,726,312 (€17,408/-$18,527) per patient with LPD versus ₫316,944,491 (€12,692/ $13,508) per patient with sVLPD (difference, -₫117,781,820 [-€4716 €/$5020).
Ketoanalogue-supplemented VLPD lowered costs compared with LPD in all 3 perspectives considered.
本研究旨在评估极低蛋白饮食（VLPD）联合必需氨基酸 keto 类似物与常规低蛋白饮食（LPD）在越南的成本效益。
该研究从支付者（基础情况）、患者和社会三个角度进行。一个马尔可夫模型模拟了终生接受慢性肾脏病 4 或 5 期（CKD4+）患者的成本和生活质量调整生命年（QALYs）。患者接受 VLPD（0.3-0.4g/kg/d 饮食）联合 keto 类似物（5kg/d [1 片]）或 LPD（0.6g/kg/d，混合蛋白）治疗。在每个模型周期中，患者在 CKD4+（非透析）、透析和死亡之间的健康状态转移基于从已发表文献中获得的转移概率。时间范围涵盖队列的寿命。效用和成本从文献回顾中估算，并为模型中考虑的寿命进行预测。进行了概率和确定性敏感性分析。
与 LPD 相比，补充 keto 类似物的 VLPD 增加了生存和 QALYs。从支付者的角度来看，在越南，接受 LPD 的每位患者的总护理费用为 216,854,268 越南盾（8684 欧元/9242 美元），而接受补充 VLPD（sVLPD）的每位患者的总护理费用为 200,928,819 越南盾（8046 欧元/8563 美元）（差异为 -15,925,449 越南盾[-638/-$679]）。从患者的角度来看，在越南，接受 LPD 的每位患者的总护理费用为 217,872,043 越南盾（8724 欧元/9285 美元），而接受 sVLPD 的每位患者的总护理费用为 116,015,672 越南盾（4646 欧元/4944 美元）（差异为 -101,856,371 越南盾[-4,079/ -$4341]）。从社会角度来看，在越南，接受 LPD 的每位患者的总护理费用为 434,726,312 越南盾（17,408 欧元/18,527 美元），而接受 sVLPD 的每位患者的总护理费用为 316,944,491 越南盾（12,692 欧元/13,508 美元）（差异为 -117,781,820 越南盾[-4716 欧元/$5020]）。
在所有 3 个考虑的视角中，补充 keto 类似物的 VLPD 均降低了与 LPD 相比的成本。
