Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
Semin Nephrol. 2024 May-Jul;44(3-4):151554. doi: 10.1016/j.semnephrol.2024.151554. Epub 2024 Sep 3.
The increasing burden of chronic kidney disease (CKD) on the health care system highlights the need to prioritize services and manage the use of resources efficiently. Amid these financial constraints, key decision makers must weigh the impact of an intervention or program on health care expenditure when determining the allocation of limited resources. Patient-reported outcome measures (PROMs) are relevant in health economic decision-making within nephrology. Health-related quality of life, a patient-reported outcome, can provide data that inform economic evaluations of treatments for patients with CKD. PROMs help determine the value of different therapies by assessing their impact on patients' daily lives beyond clinical outcomes and can help policymakers make decisions about funding and reimbursement that consider the priorities and preferences of patients. Economic evaluations often employ cost-utility analyses, which use quality-adjusted life years as a key metric. Quality-adjusted life years combine both the quality and quantity of life lived, allowing for comparison of the effectiveness of different interventions in a standardized manner. By integrating utilities derived from PROMs, these analyses quantify the benefits of CKD treatments in terms of how patients feel and function. Furthermore, PROMs contribute to quality improvement initiatives by identifying areas where patient care can be enhanced, guiding the implementation of programs that improve health-related quality of life while maintaining cost-effectiveness. In value-based financing environments, the integration of PROMs ensures that patient-centered outcomes are prioritized, leading to more effective and equitable health care delivery. In this article, we discuss the role of PROMs in economic evaluations in CKD and provide an overview of approaches for using PROMs in economic evaluations to inform decision-making in nephrology.
慢性肾脏病（CKD）给医疗保健系统带来的负担日益加重，这凸显出需要优先考虑服务并有效地管理资源的使用。在这些财政限制下，关键决策者在确定有限资源的分配时，必须权衡干预措施或计划对医疗保健支出的影响。患者报告的结局测量（PROMs）在肾脏病学的卫生经济决策中具有相关性。健康相关的生活质量是患者报告的结局，可以为 CKD 患者治疗的经济评估提供数据。PROMs 通过评估其对患者日常生活的影响，超越临床结果，帮助确定不同疗法的价值，并可以帮助决策者做出有关资金和报销的决策，同时考虑患者的优先事项和偏好。经济评估通常采用成本效用分析，该分析使用质量调整生命年来作为关键指标。质量调整生命年结合了生活的质量和数量，允许以标准化的方式比较不同干预措施的效果。通过整合来自 PROMs 的效用值，这些分析从患者的感受和功能角度量化 CKD 治疗的获益。此外，PROMs 通过确定可以改善患者护理的领域，为质量改进倡议做出贡献，指导实施改善健康相关生活质量的方案，同时保持成本效益。在基于价值的融资环境中，PROMs 的整合确保以患者为中心的结局得到优先考虑，从而实现更有效和公平的医疗保健服务。在本文中，我们讨论了 PROMs 在 CKD 经济评估中的作用，并提供了在经济评估中使用 PROMs 的方法概述，以告知肾脏病学的决策。
