The cost of implementing UK guidelines for the management of chronic kidney disease
The cost of implementing UK guidelines for the management of chronic kidney disease
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DOI：
10.1093/ndt/gfm248
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发表时间：
2007-09-01
影响因子：
6.1
通讯作者：
Farmer, Christopher K. T.
中科院分区：
文献类型：
--
作者：
Klebe, Bernhard;Irving, Jean;Farmer, Christopher K. T.
背景慢性肾脏病（CKD）是一个主要的公共卫生问题。在英国，已制定了指导方针，以促进病例识别和管理。我们的目的是估计对新发现的慢性肾脏病病例实施指南的年化成本。方法。我们使用Java程序查询了通过计算机评估进行早期肾脏干预的新机会（NEOERICA）数据库，该程序用于将CKD指南重新编译为基于规则的决策树。这将所有在1年内记录血清肌酐的患者归类为需要更多检查或转诊的患者。根据指南进行了12个月的成本分析。在第一年，10000例患者的实践将确定147.5例患有3-5期CKD的患者，超过已知的患者。所有4-5期CKD病例都需要肾脏科转诊。在3期CKD患者中（143.85），126.27名稳定患者需要更多的检查。以下情况需要转诊：估计肾小球滤过率下降>= 5 ml/min/1.73 m2/年的患者为14.8例，血红蛋白< 11 g/dl的患者为1.11例，血压> 150/90的患者为1.67例，均使用了三种抗高血压药物。研究稳定的3期CKD的每个实践的预计成本是6111的元素;是肾病转诊的7836的元素。总成本是一个元素的17 133在第一年增加到是一个元素的29 790通过肌酐校准的影响。CKD指南的实施导致肾病转诊和额外检查的显著增加。根据指南，每10 000例患者中有1例患者的透析要求延迟1年，可收回这些费用。
Background. Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases.Methods. We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed.Results. In the first year, a practice of 10 000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline >= 5 ml/min/ 1.73m(2)/year, 1.11 with haemoglobin < 11 g/dl and 1.67 with blood pressure > 150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was is an element of 6111; and is an element of 7836 for nephrology referral. Total costs of is an element of 17 133 in the first year were increased to is an element of 29 790 through the effect of creatinine calibration.Conclusions. CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10 000 patients managed according to guidelines.