Roberts S D, Maxwell D R, Gross T L
Arch Intern Med. 1981 Jun;141(7):855-8.
Payment for home hemodialysis aides has been proposed as a means of inducing shifts from center hemodialysis to less-expensive home hemodialysis. By using a simulation model, we computed the cost per life year of end-stage renal disease care when changes in the proportions of patients treated by center for home hemodialysis are brought about by paying for home hemodialysis aides. If all home hemodialysis patients receive payment for aides, total costs will increase unless there are sufficient shifts from center to home hemodialysis to offset the increased costs. The cost-effectiveness of home hemodialysis aides is critically dependent on who receives a paid aide, the salary of the aid, and the number of patients who move from center to home hemodialysis. Poorly formulated regulations may jeopardize the cost-effectiveness of home hemodialysis and increase the total cost of end-stage renal disease care.
为家庭血液透析助手支付费用已被提议作为一种促使患者从中心血液透析转向成本较低的家庭血液透析的手段。通过使用模拟模型，我们计算了在通过为家庭血液透析助手支付费用来改变接受中心血液透析和家庭血液透析治疗的患者比例时，终末期肾病护理的每生命年成本。如果所有家庭血液透析患者都能获得助手费用支付，除非有足够多的患者从中心血液透析转向家庭血液透析以抵消增加的成本，否则总成本将会增加。家庭血液透析助手的成本效益严重取决于谁能获得付费助手、助手的薪资以及从中心血液透析转向家庭血液透析的患者数量。制定不当的规定可能会损害家庭血液透析的成本效益，并增加终末期肾病护理的总成本。
