目的: 比较在中国终末期肾病（End-Stage Kidney Disease, ESKD）患者中应用基于中截留量膜技术的延展性血液透析（Expanded Hemodialysis, HDx）与血液透析滤过（Hemodiafiltration, HDF）的经济性,为临床及政策决策提供参考依据。方法: 从医疗卫生体系视角构建不良事件决策树模型,应用最小成本分析法对比1年中每周1次HDx与HDF的治疗成本,并对关键参数进行敏感性分析。结果: 在14个透析器可单独收费省份的现行价格体系下,当中截留量透析器定价在278.00元/支以下时,HDx较HDF每人每年平均节约5674.51元。敏感性分析显示医疗服务价格、中截留量透析器和血液滤过器价格对结果影响较显著。结论: HDx相比HDF可能具备经济性优势。本研究结果可为ESKD患者治疗方案的选择提供药物经济学证据参考,同时也为卫生资源的优化与高效配置提供依据。
Abstract
Objective: The paper compared the cost-effectiveness of expanded hemodialysis (HDx) enabled by medium cut-off (MCO) membrane technology and hemodiafiltration (HDF) in patients with end-stage kidney disease (ESKD) in China, providing reference for clinical treatment and policy decision-making. Methods: An adverse event decision-tree model was developed from the perspective of the healthcare system, employing the cost minimization analysis to compare costs of HDx and HDF once a week within a one-year time horizon. Sensitivity analysis was performed on key parameters. Results: Within the current pricing regimes in 14 provinces where dialyzers can be charged separately, HDx was associated with an average annual cost saving of 5674.51 yuan per patient compared with HDF when the price of MCO dialyzer was below 278.00 yuan per unit. Medical service fees, MCO dialyzer cost, and hemofilter cost were identified as the most influential factors by sensitivity analysis. Conclusion: HDx may show economic advantages over HDF. These findings will provide valuable pharmacoeconomic evidence for the selection of treatment plans for ESKD patients, and provide a basis for the optimization and efficient allocation of health resources.
关键词
延展性血液透析 /
终末期肾病 /
中截留量透析膜 /
最小成本分析
Key words
expanded hemodialysis /
end-stage kidney disease /
medium cut-off membrane /
cost minimization analysis
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