陳民 1 , 李孜 1 , 何強 2 , 蘇白海 1 , 羅海 1 , 馬行一 1 , 薛痕 1 , 康德英 3 , 簡訊 4 , 樊均明 1
  • 1. 四川大學華西醫(yī)院腎內(nèi)科,成都,6100412. 四川省人民醫(yī)院腎內(nèi)科3. 四川大學華西醫(yī)院中國循證醫(yī)學中心4. 綿陽市四零四醫(yī)院腎內(nèi)科,綿陽,621000;

目的 　通過分析比較血液透析、腹膜透析和腎移植3種替代治療早期的成本-效用,對腎替代治療進行衛(wèi)生經(jīng)濟學評價,為臨床醫(yī)生和病人選擇腎替代治療方案提供參考.
方法 　對2003年1月至2003年12月6所醫(yī)院196例(腎移植63例,血透組82例,腹透組5例)行腎替代治療的終末期腎病病人進行前瞻性研究,隨訪3個月.采用WHOQOL-BRIEF量表簡表調(diào)查終末期腎病病人健康相關(guān)生存質(zhì)量(HRQOL),從而獲得各期的效用性,成本來源于醫(yī)院財務(wù)部門和問卷調(diào)查.
結(jié)果 　頭三個月,經(jīng)腎替代治療后,腎移植組效用為0.5399±0.013,血透組0.4508±0.014,CAPD組0.5122±0.099.腎移植組的直接成本明顯高于血透組和腹透組.經(jīng)成本-效用分析,腹透組每獲得1個質(zhì)量調(diào)整生命年(QALY)的成本(cost-utility ratio, CUR)低于血透組和腎移植組,腎移植組每個QALY的成本又低于血透組.增量成本-效用分析結(jié)果顯示,腹透組最經(jīng)濟,以血透組為對照,腎移植組追加成本高于腹透組.敏感性分析顯示,隨著ΔQALY在95%可信區(qū)間內(nèi)變化,腹透組優(yōu)于腎移植組,而腎移植組與血透組和腹透組與血透組的成本-效用孰優(yōu)孰劣隨ΔQALY變化而波動.
結(jié)論 　腎替代治療初期腹透組的成本-效用優(yōu)于腎移植組;腎移植組與血透組及腹透組與血透組在治療初期的成本-效用孰優(yōu)孰劣尚不能得出肯定結(jié)論.

引用本文： 陳民,李孜,何強,蘇白海,羅海,馬行一,薛痕,康德英,簡訊,樊均明. 腎替代治療初期的成本-效用分析. 中國循證醫(yī)學雜志, 2004, 04(7): 453-459. doi: 復制

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  13. 13. 楊樟衛(wèi),張鈞.成本效用分析方法與應用 [J].中國藥房,1998; 9(2):54～55.
  14. 14. ［8］Rodriguez-Carmona A,Perez Fontan M,Bonza P,Garcia Falcon T,Valdes F.The economic cost of dialysis:a comparison between Peritoneal dialysis and in-center hemodialysis in a Spanish Unit [J].Adv Perit Dial,1996; 12:93-96.
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