Illustrating the impact of including future costs in economic evaluations: an application to end-stage renal disease care
Illustrating the impact of including future costs in economic evaluations: an application to end-stage renal disease care
复制标题
DOI：
10.1002/hec.790
复制
发表时间：
2003-11-01
期刊：
影响因子：
2.1
通讯作者：
Donaldson, C
中科院分区：
文献类型：
--
作者：
Manns, B;Meltzer, D;Donaldson, C
将相关和不相关的医疗保健和非医疗支出的未来成本计入经济评估有很强的理论依据。然而，关于纳入这类费用在实践中如何影响医疗干预的成本效益的数据有限。对于提高终末期肾病(ESRD)患者存活率的低成本干预措施，我们试图确定相关医疗护理(如透析和移植)以及非相关医疗护理和非医疗支出的未来成本将如何影响每QALY成本比率的大小。我们进行了一项成本效用分析，比较了使用合成透析器的血液透析(加拿大目前选择的治疗方法)和历史上的黄金标准治疗方法(使用纤维素透析器)。我们对比了分析的结果，包括和排除了未来成本的各种衡量标准。虽然纳入非相关医疗保健和非医疗支出的未来费用对每QALY费用比率有重大影响，但每QALY费用比率的大小对纳入相关医疗保健的未来费用最为敏感。我们的分析表明，即使是相对便宜的延长透析患者生存期的干预措施也可能不具成本效益，因为通过延长生存期，所产生的额外门诊透析费用是巨大的。在这一领域的经济评估中纳入这些成本(这本身在方法上是正确的)可能会减轻对本身相对便宜但可以改善患者生存的干预措施的接受程度。版权所有(C)2003 John Wiley Sons，Ltd.
There are strong theoretical arguments for including future costs for related and unrelated medical care and non-medical expenditures within economic evaluations. Nevertheless, there is limited data on how inclusion of such costs affects the cost effectiveness of medical interventions in practice. For a low-cost intervention that improves survival in end-stage renal disease (ESRD) patients, we sought to determine how the inclusion of future costs for related medical care (i.e. dialysis and transplantation) and for unrelated medical care and non-medical expenditure would affect the magnitude of the cost per QALY ratio. We performed a cost-utility analysis comparing hemodialysis using a synthetic dialyser (the current treatment of choice in Canada) with the historical gold-standard treatment (use of a cellulose dialyser). We contrasted the results of the analysis including and excluding various measures of future costs. While the inclusion of future costs for unrelated medical care and non-medical expenditures had a significant impact on the cost per QALY ratio, the size of the cost per QALY ratio was most sensitive to inclusion of future costs for related medical care. Our analysis shows that even relatively inexpensive interventions that extend survival of dialysis patients may not be cost-effective since, by extending survival, the extra outpatient dialysis costs that are incurred are large. Inclusion of such costs (which, in and of itself, is methodologically correct) in economic evaluations in this area may mitigate against the acceptance of interventions that are relatively inexpensive themselves but which improve patient survival. Copyright (C) 2003 John Wiley Sons, Ltd.