Coyte P C, Young L G, Tipper B L, Mitchell V M, Stoffman P R, Willumsen J, Geary D F
Department of Health Administration, University of Toronto, Ontario, Canada.
Am J Kidney Dis. 1996 Apr;27(4):557-65. doi: 10.1016/s0272-6386(96)90167-5.
The purpose of this study was to assess the relative health system cost of pediatric ambulatory hospital-based hemodialysis and home-based peritoneal dialysis, including both continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis when either treatment is equally appropriate. A cost analysis was performed from the viewpoint of the "study hospital" and service providers (physicians) using treatment protocols, based on current clinical practice, which incorporate procedures to establish dialysis access sites, ongoing dialysis maintenance, and possible complications. Cost estimates used information from the period between April 1, 1993, to March 31, 1994, including fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on treatment costs. Total annual costs (in 1994 Canadian dollars, $1.00 CDN approximately $0.75. US) of a typical and uncomplicated continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, and hemodialysis patient were $47,569, $48,658, and $76,023, respectively. Differences in cost between peritoneal dialysis and hemodialysis patients were due to hemodialysis maintenance costs, which were attributed to larger physician fees (25.8 percent), greater direct treatment costs incurred by the study hospital (14.2 percent), and higher overhead costs (60.0 percent). The expected total cost of hemodialysis complicated by an arteriovenous fistula clot and central venous line blockages, or peritoneal dialysis complicated by hernia repair and peritonitis was $78,568 and $50,438 for hemodialysis and peritoneal dialysis, respectively. For the range of complication probabilities considered, expected total costs were always lower with peritoneal dialysis than with hemodialysis. The cost analysis demonstrates that peritoneal dialysis is less costly than hemodialysis for pediatric patients. Such analyses are but one component of the treatment decision, and as such, should not be viewed as the sole means to yield a treatment decision, but rather as a device for systematically evaluating the alternative treatment options.
本研究的目的是评估以医院为基础的小儿门诊血液透析与家庭腹膜透析的相对卫生系统成本，其中家庭腹膜透析包括持续非卧床腹膜透析和持续循环腹膜透析，前提是两种治疗方法都同样适用。从“研究医院”和服务提供者（医生）的角度，根据当前临床实践，利用治疗方案进行成本分析，该方案纳入了建立透析通路部位、持续透析维持以及可能并发症的程序。成本估算采用了1993年4月1日至1994年3月31日期间的信息，包括全额分摊的住院和门诊成本。进行了敏感性分析，以分析并发症对治疗成本的影响。典型且无并发症的持续非卧床腹膜透析、持续循环腹膜透析和血液透析患者的年度总成本（以1994年加元计，1.00加元约合0.75美元）分别为47,569加元、48,658加元和76,023加元。腹膜透析和血液透析患者的成本差异归因于血液透析的维持成本，这是由于医生费用较高（25.8%）、研究医院产生的直接治疗成本较高（14.2%）以及间接费用较高（60.0%）。因动静脉内瘘血栓形成和中心静脉导管堵塞而并发的血液透析，或因疝气修补和腹膜炎而并发的腹膜透析，其预期总成本分别为血液透析78,568加元和腹膜透析50,438加元。在所考虑的并发症概率范围内，腹膜透析的预期总成本始终低于血液透析。成本分析表明，对于小儿患者，腹膜透析的成本低于血液透析。此类分析只是治疗决策的一个组成部分，因此，不应被视为做出治疗决策的唯一手段，而应被视为系统评估替代治疗方案的一种工具。
