• 1. 四川大學(xué)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(xué)華西醫(yī)院中國循證醫(yī)學(xué)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(jìn)行衛(wèi)生經(jīng)濟(jì)學(xué)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(jìn)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(jì),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(qiáng),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(xué)雜志, 2004, 04(7): 453-459. doi: 復(fù)制

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  4. 4. ［3］Wang JL,Editor-in-chief.Clinical Epidemiology-ClinicalResearch Design,Measurement and Evaluation [M].2nd ed.Shanghai:Shanghai Science Technology Publication House,2001; p.373-375.
  5. 5. 王家良,主編.臨床流行病學(xué)--臨床科研設(shè)計(jì)、衡量與評價 [M].第2版.上海:上海科學(xué)技術(shù)出版社,2001.p373～375.
  6. 6. ［4］Wang JL,Editor-in-chief.Evidence-Based Medicine [M].1st ed.Beijing:People’s Medical Publishing House,2001; p.102-104.
  7. 7. 王家良,主編.循證醫(yī)學(xué) [M].第1版.北京:人民衛(wèi)生出版社,2001.p102～104.
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  11. 11. 何鴻明,周采銘.衛(wèi)生經(jīng)濟(jì)學(xué) [M].第1版.上海:上?？茖W(xué)普及出版社,1987.p227～228.
  12. 12. ［7］Yang ZW,Zhang J.The method and application of Cost-Utility Analysis [J].China Pharmacy,1998; 9(2):54-55.
  13. 13. 楊樟衛(wèi),張鈞.成本效用分析方法與應(yīng)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.
  15. 15. ［9］Kaminota M.cost-effectiveness analysis of dialysis and kidney transplants in Japan [J].Keio J Med,2001; 50(2):100-108.