{"title":"快速成本效益分析：卢旺达急性肾损伤患者的血液透析与腹膜透析。","authors":"Cassandra Nemzoff, Nurilign Ahmed, Tolulope Olufiranye, Grace Igiraneza, Ina Kalisa, Sukrit Chadha, Solange Hakiba, Alexis Rulisa, Matiko Riro, Kalipso Chalkidou, Francis Ruiz","doi":"10.1186/s12962-024-00545-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.</p><p><strong>Methods: </strong>A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.</p><p><strong>Results: </strong>The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.</p><p><strong>Conclusion: </strong>Dialysis is costly and covered by insurance in many countries for the financial protection of patients. 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引用次数: 0
摘要
背景：为确保其社区医疗保险计划的长期可持续性，卢旺达政府正在努力利用卫生技术评估（HTA）来确定卫生资源的优先次序。本研究的目的是快速评估(1)在卢旺达三级医疗机构为急性肾损伤（AKI）患者提供腹膜透析与血液透析的成本效益和(2)对预算的影响：对急性肾损伤患者进行了快速成本效益分析，以帮助确定优先次序。由于时间和数据限制，对国际决策支持计划参考病例进行了调整，从而采用了 "适应性 "HTA 方法。利用现有的本地和国际数据分析了腹膜透析（PD）与血液透析（HD）在三级医院环境中的成本效益和预算影响：结果：分析发现，从支付方的角度来看，对于大多数 AKI 患者（年龄在 15-49 岁之间）而言，血液透析的效果略好，费用略高。如果仅对这两种透析策略进行比较，则 HD 似乎具有成本效益，在人均国内生产总值（444,074 卢旺达法郎或 431 美元）为 0.5 倍的临界值下，增量成本效益比为 378,174 卢旺达法郎或 367 美元。敏感性分析发现，降低 HD 套件的成本将使 HD 更具成本效益。腹膜透析成本仍存在不确定性。预算影响分析表明，降低最大的成本驱动因素--人类免疫缺损病毒药包的成本，可在五年内产生的节余要比改用腹膜透析多得多。因此，价格谈判可以大大提高血液透析的效率：透析费用高昂，在许多国家，透析费用由保险支付，以保障患者的经济利益。这项分析使决策者能够做出基于证据的决策，以提高透析服务的效率。
Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda.
Background: To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.
Methods: A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.
Results: The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.
Conclusion: Dialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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