血液透析､腹膜透析和肾移植的成本-效果分析

目的 探讨我院行血液透析(HD)&#65380;腹膜透析(CAPD)和肾移植(KT)3种终末期肾脏病(ESRD)替代疗法第1&#65380;第2年的成本-效果比&#65377;方法 回顾性研究上述3种疗法患者开始治疗两年内的成本&#65380;对工作的影响&#65380;以及现阶段的生活质量(用SF-36量表),并进行有关分析&#65377;结果 KT组第1年的费用高于另外两组(P < 0.001);在第2年则明显低于另外两组(P=0.005),后两组间差异无统计学意义&#65377;KT组的睡眠质量&#65380;回返工作的比例均优于另外两组&#65377;在精神健康&#65380;生理职能和精力方面,KT组与CAPD组均优于HD组&#65377;在生理机能&#65380;一般健康状况&#65380;社会功能&#65380;情感职能上,KT组优于CAPD与HD组,后两组差异无统计学意义&#65377;结论 KT组从第2年开始体现其费用上的优势,而CAPD与HD两组之间在医疗成本上无显著差异&#65377;肾移植的治疗效果在整体上优于CAPD和HD,CAPD的治疗效果略优于HD&#65377;随着KT近期和远期存活率的提高,KT应是成本-效果比最好的ESRD替代治疗方法&#65377;

Cost-effectiveness analysis of hemodialysis, CAPD and kidney transplantation

Objective To Compare the cost-effectiveness among hemodialysis (HD), CAPD and kidney transplantation (KT) in the first year and the second year.Methods Patients' data of above three groups in two years were retrospectively studied, including the cost, general conditions, hemoglobin level, influence on job and functional health status (by SF-36). Results The first year's cost of KT group was higher than the other two groups, however, the second year's cost was lower. There was no significant difference between HD group and CAPD group. The general conditions, the ratio of employment, the level of hemoglobin in KT group were better than those in HD group and CAPD group. Functional health status (SF-36): in MH dimension, VT and PF dimensions, the score of KT group and CAPD group was higher than that of HD group; in RP, GH, SF, RE dimensions, the score of KT group was higher than that of HD group and CAPD group(P<0.05), and the latter two groups were not significantly different.Conclusion KT is a less cost replacement therapy than HD and CAPD from the second year. The cost of HD and CAPD group is not significantly different within two years. The effectiveness of KT is better than HD and CAPD. The effectiveness of CAPD is a little better than HD. KT is the most cost-effective therapy as the increase of short- and long-term survival.