Modelling the Cost-Effectiveness of Delaying End-Stage Renal Disease
Modelling the Cost-Effectiveness of Delaying End-Stage Renal Disease
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DOI：
10.1159/000446548
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发表时间：
2016-01-01
期刊：
影响因子：
2.5
通讯作者：
van den Hout, Wilbert B.
中科院分区：
文献类型：
--
作者：
de Vries, Eline F.;Rabelink, Ton J.;van den Hout, Wilbert B.
背景：随着终末期肾病（ESRD）发病率的上升，人们正在开发新的治疗方法来延迟ESRD。本研究的目的是建立一个通用模型，以估计延迟ESRD在7个欧洲国家的成本效益：荷兰，英国，德国，意大利，西班牙，芬兰和匈牙利。通过评估2个虚构但现实的治疗方案来说明该模型的使用。方法：使用状态转换模型估计质量调整生命年（QELS）和社会成本。使用荷兰肾脏登记处的数据估计肾脏替代治疗后的肾脏依赖性生存率。从已发表的报告中获得医疗保健成本和公用事业。考虑到各国在获得移植和生产力价值方面的差异。结果：延迟1年的ESRD估计可获得0.6个季度和0.3年的生产力。获得移植的影响很小，而节省生产力的影响很大。对于1年的免费延迟，社会储蓄将从联合王国的8，000英镑到德国的17，000英镑不等。应用阈值（原文如此）20，000 - 40，000/QALY获得，一次性基于细胞的治疗在经济上是可接受的，如果它延迟ESRD 0.2-0.5年。这将节省超过0.5年的延迟费用。如果每年的价格高于30，000美元，持续使用药物不太可能具有成本效益。结论：本研究为延缓ESRD的新疗法的经济潜力提供了证据。所构建的模型为用户提供了早期阶段的治疗方案的市场成功率的信息。(C)2016作者（s）由S. Karger AG，巴塞尔
Background: As the incidence of end-stage renal disease (ESRD) is on the rise, new therapies are being developed for delaying ESRD. This study is aimed at constructing a generic model for estimating the cost-effectiveness of delaying ESRD in 7 European countries: the Netherlands, United Kingdom, Germany, Italy, Spain, Finland and Hungary. The use of this model is illustrated by assessing 2 fictitious, but realistic therapy options. Methods: Quality-adjusted life years (QALYs) and societal costs were estimated using a statetransition model. Age-dependent survival after renal replacement therapy was estimated using data from the Dutch Renal Registry. Healthcare costs and utilities were obtained from published reports. Country-specific differences regarding access to transplantation and value of productivity were factored. Results: A 1-year delay of ESRD rendered an estimated gain of 0.6 QALYs and 0.3 years in productivity. Access to transplantation had a minimal impact, whereas savings on productivity had a significant impact. For a 1-year delay free of charge, societal savings would range from (sic)8,000 in the United Kingdom to (sic)17,000 in Germany. Applying thresholds of (sic)20,000-(sic)40,000 per QALY gained, one-time cellbased therapy would be economically acceptable if it delayed ESRD by 0.2-0.5 years. It would be cost saving for a delay in excess of 0.5 years. Continuous use of medication is unlikely to be cost-effective for prices higher than (sic)30,000 per year. Conclusion: This study provides evidence for the economic potential of new therapies delaying ESRD. The constructed model provides users with information about the market success rates of treatment options at an early stage. (C) 2016 The Author(s) Published by S. Karger AG, Basel