IS SCREENING AND INTERVENTION FOR MICROALBUMINURIA WORTHWHILE IN PATIENTS WITH INSULIN-DEPENDENT DIABETES
IS SCREENING AND INTERVENTION FOR MICROALBUMINURIA WORTHWHILE IN PATIENTS WITH INSULIN-DEPENDENT DIABETES
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DOI：
10.1136/bmj.306.6894.1722
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发表时间：
1993-06-26
影响因子：
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通讯作者：
MOGENSEN, CE
中科院分区：
文献类型：
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作者：
BORCHJOHNSEN, K;WENZEL, H;MOGENSEN, CE
目的：分析胰岛素依赖型糖尿病患者微量白蛋白尿指征早期肾病筛查及降压治疗的成本-效益。设计-先前发表的数据用于估计从正常蛋白尿到死亡的每一步的过渡概率。干预对降压治疗尿白蛋白排泄率的影响被任意设定为三个不同的水平。所有直接费用（筛查、降压治疗、终末期肾衰竭治疗）均纳入成本效益分析，实际贴现率分别为2.5%和6%。Setting-Computer模拟。受试者：模拟队列8000例患者。主要结局指标：死亡率、糖尿病肾病发生率、终末期肾衰竭发生率、费用与节省。结果：假设治疗效果为33%和67%，平均预期寿命分别增加4至14年，透析或移植需求减少21%至63%。如果蛋白尿的年增长率从20%下降到18%，成本和节省将达到平衡。结论：筛查和干预方案可能具有挽救生命的效果，并导致可观的经济节省。
Objective-To analyse the cost-benefit of screening for and antihypertensive treatment of early renal disease indicated by microalbuminuria in patients with insulin dependent diabetes mellitus.Design-Previously published data were used to estimate transition probabilities for each step from normoalbuminuria until death. The effect of intervention on urinary albumin excretion rate by antihypertensive treatment was arbitrarily set at three different levels. All direct costs (screening, antihypertensive treatment, treatment of end stage renal failure) were included in the cost-benefit analysis by using real discount rates of 2.5% and 6%.Setting-Computer simulation.Subjects-Simulated cohort of 8000 patients.Main outcome measures-Mortality, incidence of diabetic nephropathy, incidence of end stage renal failure, and costs versus savings.Results-Assuming treatment effects of 33% and 67% median life expectancy increased by four to 14 years, respectively, and the need for dialysis or transplantation decreased by 21% to 63%. Costs and savings would balance if the annual rate of increase of albuminuria was decreased from 20% to 18% a year.Conclusions-Screening and intervention programmes are likely to have life saving effects and lead to considerable economic savings.