快速成本效益分析：卢旺达急性肾损伤患者的血液透析与腹膜透析对比

Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda.

作者信息

Nemzoff Cassandra, Ahmed Nurilign, Olufiranye Tolulope, Igiraneza Grace, Kalisa Ina, Chadha Sukrit, Hakiba Solange, Rulisa Alexis, Riro Matiko, Chalkidou Kalipso, Ruiz Francis

机构信息

London School of Hygiene and Tropical Medicine, London, UK.

Center for Global Development, International Decision Support Initiative, iDSI, London, UK.

出版信息

Cost Eff Resour Alloc. 2024 Apr 30;22(1):35. doi: 10.1186/s12962-024-00545-0.

DOI:10.1186/s12962-024-00545-0

PMID:38689271

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11059575/

Abstract

BACKGROUND

To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.

METHODS

A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.

RESULTS

The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.

CONCLUSION

Dialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.

摘要

背景

为确保其基于社区的健康保险计划的长期可持续性，卢旺达政府正致力于利用卫生技术评估（HTA）来确定其卫生资源的优先次序。本研究的目的是快速评估（1）在卢旺达三级医疗机构中，为急性肾损伤（AKI）患者提供腹膜透析（PD）与血液透析（HD）的成本效益，以及（2）预算影响。

方法

对AKI患者进行了快速成本效益分析，以支持优先次序的确定。采用了一种“适应性”HTA方法，针对时间和数据限制调整了国际决策支持倡议参考案例。利用现有的本地和国际数据，分析了在三级医院环境中，腹膜透析（PD）与血液透析（HD）相比的成本效益和预算影响。

结果

分析发现，从支付方的角度来看，对于大多数AKI患者（年龄在15至49岁之间），HD的效果略好且成本略高。仅比较这两种透析策略时，HD似乎具有成本效益，增量成本效益比为378,174卢旺达法郎（RWF）或367美元（US$），阈值为人均国内生产总值的0.5倍（RWF 444,074或US$431）。敏感性分析发现，降低HD套件的成本将使HD更具成本效益。PD成本仍存在不确定性。预算影响分析表明，降低最大成本驱动因素HD套件的成本，在五年内可产生比改用PD显著更多的节省。因此，价格谈判可显著提高HD供应的效率。