Tousignant P, Guttmann R D, Hollomby D J
J Chronic Dis. 1985;38(7):589-601. doi: 10.1016/0021-9681(85)90048-7.
Transplantation and home hemodialysis treatments have been available to treat patients with end stage renal disease for several years but it is not clear which approach is most cost-effective. This study compared the costs of hemodialysis and transplantation for comparable patients using the marginal cost methodology. Sixteen patients in a home program were matched with 16 patients in a transplantation program for sex, age, primary disease and other medical diseases. Questionnaires and a chart review allowed the accounting of all health services received in hospitals, offices or at home, and provided indicators of treatment effectiveness. The impact of the additional services generated by choosing one treatment over the other (difference between the two programs) was evaluated in terms of personnel, equipment and supplies. Survival and rehabilitation were similar in the two groups. However, for each year of follow-up, transplantation was considerably less expensive than home dialysis. These results suggest that transplantation is the most cost-effective way to treat end stage renal failure, at least for the subgroup of patients equally eligible for either transplantation or home dialysis.
移植和家庭血液透析治疗方法已用于治疗终末期肾病患者数年，但尚不清楚哪种方法最具成本效益。本研究采用边际成本法比较了可比较患者的血液透析和移植成本。家庭治疗项目中的16名患者与移植治疗项目中的16名患者在性别、年龄、原发性疾病和其他内科疾病方面进行了匹配。通过问卷调查和病历审查，统计了患者在医院、诊所或家中接受的所有医疗服务，并提供了治疗效果指标。从人员、设备和耗材方面评估了选择一种治疗方法而非另一种治疗方法所产生的额外服务的影响（两个项目之间的差异）。两组患者的生存率和康复情况相似。然而，在每年的随访中，移植治疗的费用比家庭透析低得多。这些结果表明，移植是治疗终末期肾衰竭最具成本效益的方法，至少对于同等适合移植或家庭透析的患者亚组来说是如此。
