Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease.

Autor:	Couchoud C; REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France., Couillerot AL; Service évaluation économique et santé publique, Haute Autorité de Santé, Saint-Denis La Plaine, France., Dantony E; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France Université Lyon I, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France., Elsensohn MH; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France Université Lyon I, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France., Labeeuw M; REIN Registry, Hospices Civils de Lyon, Lyon, France., Villar E; Université Lyon I, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France Nephrology Unit, Saint Luc Saint Joseph Hospital, Lyon, France., Ecochard R; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France Université Lyon I, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France., Bongiovanni I; Service évaluation économique et santé publique, Haute Autorité de Santé, Saint-Denis La Plaine, France.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2015 Dec; Vol. 30 (12), pp. 2054-68. Date of Electronic Publication: 2015 Aug 12.
DOI:	10.1093/ndt/gfv300
Abstrakt:	Background: This study assumed that some patients currently treated at hospital-based haemodialysis centres can be treated with another renal replacement therapy (RRT) modality without any increase in mortality risk and sought to evaluate the monthly cost impact of replacing hospital-based haemodialysis, for which fees are highest, by different proportions of other modalities. Methods: We used a deterministic model tool to predict the outcomes and trajectories of hypothetical cohorts of incident adult end-stage renal disease (ESRD) patients for 15 years of RRT (10 different modalities). Our estimates were based on data from 67 258 patients in the REIN registry and 65 662 patients in the French national health insurance information system. Patients were categorized into six subcohorts, stratified for age and diabetes at ESRD onset, and analyses run for each subcohort. We simulated new strategies of care by changing any or all of the following: initial distributions in treatment modalities, transition rates and some costs. Strategies were classified according to their monthly per-patient cost compared to current practices (cost-minimization analysis). Results: Simulations of the status quo for the next 15 years predicted a per-patient monthly cost of €2684 for a patient aged 18-45 years without diabetes and €7361 for one older than 70 years with diabetes. All of the strategies we analysed had monthly per-patient costs lower than the status quo, except for daily home HD. None impaired expected survival. Savings varied by strategy. Conclusions: Alternative strategies may well be less expensive than current practices. The decision to implement new strategies must nonetheless consider the number of patients concerned, feasibility of renal care reorganization, and investment costs. It must also take into account the role of patients' choice and the availability of professionals. (© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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