评估体外肾替代疗法:平衡预算考虑与伦理影响。

IF 1.8 3区 医学 Q3 HEMATOLOGY
Blood Purification Pub Date : 2025-01-01 Epub Date: 2025-03-28 DOI:10.1159/000545389
Gonzalo Ramírez-Guerrero, Fiammetta Zanetti, Akash Nayak Karopadi, Claudio Ronco
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引用次数: 0

摘要

评估终末期肾病(ESKD)患者体外疗法的前景需要强调成本效益和以患者为中心的护理之间的关键平衡。本手稿对意大利和美国医疗系统中的这些技术进行了评估。意大利每年的透析费用超过 20 亿欧元,美国每年的透析费用超过 290 亿美元,因此必须根据新技术的临床效益评估其经济影响。成本效益分析(CEA)和卫生技术评估(HTA)是评估医疗干预措施的重要工具,但它们往往无法反映患者生活质量的质的改善。对于可带来重大长期益处的治疗方法,伦理方面的考虑至关重要。本文介绍了一个评估成本效益的二维框架,并说明了一些情况,强调了在考虑经济指标的同时优先考虑患者疗效的重要性。此外,本文还提倡将生物伦理原则--如正义、平等和公平--纳入成本效益评估,确保干预措施的评估不仅考虑其经济可行性,还考虑其社会和伦理价值。通过将伦理维度纳入 CEA 框架,医疗保健系统可以更好地应对资源分配的复杂性,促进创新,并最终改善 ESKD 及其他疾病的患者护理。这种方法旨在确保医疗服务公平、有效,并对患者的细微需求保持敏感。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating Extracorporeal Renal Replacement Therapies: Balancing Budgetary Considerations with Ethical Implications.

Background: Evaluating extracorporeal therapies for end-stage kidney disease (ESKD) requires balancing cost-effectiveness with patient-centered care. With dialysis costs exceeding EUR 2 billion annually in Italy and USD 29 billion in the USA, assessing the economic implications of emerging technologies against their clinical benefits is crucial. Cost-effectiveness analysis (CEA) and health technology assessment (HTA) are widely used to evaluate healthcare interventions, yet they often fail to capture qualitative improvements in patients' quality of life. Additionally, ethical considerations remain underrepresented in these frameworks, despite their importance in guiding equitable resource allocation.

Summary: This manuscript examines the landscape of extracorporeal therapies within the healthcare systems of Italy and the USA, highlighting the economic and ethical challenges in their evaluation. A novel two-dimensional framework is introduced, integrating bioethical principles - such as justice, equality, and equity - into CEA to ensure that interventions are assessed not only for their financial sustainability but also for their societal and ethical impact. By incorporating ethical considerations into CEA, the framework offers a more comprehensive approach to decision-making in healthcare resource allocation.

Key messages: (1) Traditional CEA and HTA methods often overlook qualitative improvements in patient quality of life. (2) Ethical considerations, including justice and equity, should be integrated into economic evaluations of healthcare interventions. (3) A two-dimensional framework is proposed to balance economic viability with patient-centered outcomes. (4) Incorporating ethics into CEA enhances healthcare decision-making, fostering innovation and equitable patient care.

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来源期刊
Blood Purification
Blood Purification 医学-泌尿学与肾脏学
CiteScore
5.80
自引率
3.30%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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