乌克兰通过透析肾替代疗法治疗 5D 期慢性肾病患者的经济问题:一项单中心研究

А.Yu. Shymova, I. Shifris, Е. Krasiuk
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引用次数: 0

摘要

背景。这项研究旨在根据对一家医疗机构使用血液透析(HD)和腹膜透析(PD)的成本分析,确定 2023 年通过肾脏替代疗法(RRT)透析方法治疗 5D 期慢性肾脏病(CKD)患者的成本。材料和方法。基辅市肾脏病和透析中心开展了一项开放式单中心研究。2023 年期间,779 名 5D 期慢性肾病患者在该机构接受了透析肾替代治疗。其中,718 人接受了血液透析治疗,61 人接受了腹膜透析治疗(36 人接受了连续不卧床腹膜透析(CAPD),25 人接受了自动腹膜透析(APD))。在计算采用这两种透析方法治疗慢性肾病患者的成本时,包括了直接医疗和非医疗成本。一名患者一年的治疗费用估算公式为:使用血液透析/血液透析滤过(HDF)方法时--1 次治疗的费用 × 156 次治疗;使用自动腹膜透析(APD)方法时--1 个治疗日的费用 × 365 天。结果。通过对 5D 期 CKD 患者治疗费用的分析,我们可以得出 2023 年一次 HD/HDF 治疗的平均费用为 3626.20 乌吉亚,一天 CAPD 和 APD 治疗的费用分别为 1539.78 乌吉亚和 1829.12 乌吉亚。2023 年期间,采用 HD/HDF 方法治疗一名患者的平均费用为 565 687.20 乌吉亚,CAPD 为 562 019.70 乌吉亚,APD 为 667 628.80 乌吉亚。在治疗费用结构中,无论采用哪种 RRT 方式,最昂贵的部分都是耗材费用。根据《2023 年医疗保障计划》,当年治疗一名 5D 期 CKD 患者的国家报销额度为:使用 GD/GDF 时 385 788 乌吉亚,使用 CAPD 时 412 085 乌吉亚,使用 APD 时 662 110 乌吉亚。也就是说,根据我们获得的数据,医疗保障计划仅支付了医疗机构使用 HD/HDF 治疗费用的 68.2%,使用 CAPD 治疗费用的 73.3%,使用 APD 治疗费用的近 100%。结论使用 RRT 透析方法治疗 5D 期 CKD 患者的实际费用高于国家报销比例。医疗保障计划并不能完全支付医疗机构使用 RRT 方法治疗 5D 期 CKD 患者的费用。CAPD 在医疗和经济效益方面都具有无可争议的优势。此外,与战争期间的其他透析方式相比,使用 CAPD 的优势在于无需依赖水电供应、医务人员的数量和工作量、患者无需经常前往透析中心。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Economic issues of treating patients with stage 5D chronic kidney disease by dialysis methods of renal replacement therapy in Ukraine: a single-center study
Background. The aim of the work was to determine the cost of treating patients with stage 5D chronic kidney disease (CKD) by dialysis methods of renal replacement therapy (RRT) in 2023 based on the analysis of the costs of using hemodialysis (HD) and peritoneal dialysis (PD) in one medical institution. Materials and methods. An open single-center study was conducted at the Кyiv City Center of Nephrology and Dialysis. During 2023, 779 patients with stage 5D chronic kidney disease received renal replacement therapy by dialysis methods in this institution. Among them, 718 participants were treated by hemodialysis and 61 patients by peritoneal dialysis (36 by continuous ambulatory peritoneal dialysis (CAPD) and 25 by automated peritoneal dialysis (APD)). Direct medical and non-medical costs were included in the calculation of the cost of treating chronic kidney disease patients using both dialysis methods. The estimate of the cost of treatment for one patient during the year was calculated according to the formula: when using hemodialysis/hemodiafiltration (HDF) method — the cost of 1 session × 156 sessions, in case of CAPD/APD — the cost of 1 treatment day × 365 days. Results. The analysis of the costs for the treatment of patients with stage 5D CKD allowed us to state that the average cost of one HD/HDF session in 2023 was 3,626.20 UAH, one day of CAPD and APD treatment was 1,539.78 and 1,829.12 UAH, respectively. The average cost of treatment of one patient by HD/HDF method during 2023 was 565,687.20 UAH, CAPD — 562,019.70 UAH, APD — 667,628.80 UAH. In the structure of the cost of treatment, regardless of the modality of RRT, the most expensive component is the cost of consumables. State reimbursement under the Program of Medical Guarantees in 2023 for the treatment of one patient with stage 5D CKD during the year was 385,788 UAH when using GD/GDF, 412,085 UAH for CAPD, 662,110 UAH for APD. That is, based on the data we received, the Program of Medical Guarantees covers only 68.2 % of the costs of medical institution for the treatment with HD/HDF, 73.3 % for the treatment with CAPD and almost 100 % for the treatment with APD. Conclusions. The real cost of treating patients with stage 5D CKD using dialysis methods of RRT is higher than the rate of state reimbursement. The Program of Medical Guarantees doesn’t fully cover the costs of medical institutions for the treatment of patients with stage 5D CKD using RRT methods. CAPD has indisputable advantages in terms of both medical and economic benefit. In addition, the advantage of using CAPD over other dialysis modalities during the war is the absence of dependence on water and electricity supply, the number and workload of medical personnel, the need for patients to constantly visit the dialysis center.
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