THE COST IMPACT OF CYTOMEGALOVIRUS DISEASE IN RENAL TRANSPLANT RECIPIENTS
THE COST IMPACT OF CYTOMEGALOVIRUS DISEASE IN RENAL TRANSPLANT RECIPIENTS
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巨细胞病毒病对肾移植受者的费用影响
DOI：
10.1097/00007890-199306000-00013
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发表时间：
1993
期刊：
影响因子：
6.2
通讯作者：
P. Keown
中科院分区：
文献类型：
--
作者：
J. McCarthy;M. Karim;H. Krueger;P. Keown
进行了一项回顾性病例对照研究，以确定肾移植后第一年巨细胞病毒疾病的成本影响，作为分析针对巨细胞病毒感染的预防和治疗方案的成本效益的基础。从1988年1月1日至1990年3月31日在同一所大学附属实体器官移植单位连续进行的119例首次尸体肾移植受者中，11例器官特异性巨细胞病毒疾病与22例年龄、糖尿病状态和供体/受体巨细胞病毒血清学状态的对照相匹配。两组在性别、HLA匹配和不匹配、初始移植物功能障碍发生率和免疫抑制方面具有可比性。所有33名受试者在移植后一年内的住院数据、资源利用和费用。CMV病例和对照组的平均初次住院时间相当（14.5天和15.0天，P=NS），但发生CMV疾病的患者在移植后第一年平均住院时间为59天，而对照组为22天（P=0.001）。平均31天住院与巨细胞病毒疾病直接相关。以1988年加元计算，CMV疾病患者的平均机构总成本是对照组的2.5倍（42,611美元对17,309美元，P=0.001），主要反映在普通病房（19,988美元对7484美元，P=0.001）、酒店（2508美元对927美元，P=0.001）、临床实验室（5420美元对2558美元，P=0.0001）、放射科（1581美元对640美元，P=0.05）和药房（4916美元对1782美元，P=0.01）的成本和利用上的差异。两组间的手术室、特殊病房、辅助设施和平均每日费用（719美元vs 790美元，P=NS）无显著差异。巨细胞病毒患者的1年功能性移植存活率为72%，而对照组为86%，移植的平均计算成本效益降低了2.9倍。这些数据表明，巨细胞病毒疾病由于住院时间延长对肾移植有显著的经济影响。为了开发一种具有成本效益的巨细胞病毒感染管理方法，在评估治疗和预防方案以及器官分配方案时必须考虑到这种影响。
A retrospective case controlled study was performed to determine the cost impact of cytomegalovirus disease in the first year following renal transplantation as a basis for the analysis of cost effectiveness of prophylactic and therapeutic regimens directed at CMV infection. Eleven sequential cases of organ-specific CMV disease were matched with 22 controls for age, diabetic status, and donor/recipient CMV serologic status from 119 consecutive first cadaveric renal transplant recipients performed at a single university-affiliated, solid organ transplant unit between January 1, 1988 and March 31, 1990. The groups were comparable for sex, HLA match and mismatch, incidence of initial graft dysfunction, and immunosuppression. Hospitalization data, resource utilization, and costs for all 33 subjects were obtained for a one-year period after transplantation. The mean initial hospitalization time was comparable for both CMV cases and controls (14.5 vs. 15.0 days, P=NS), but patients developing CMV disease averaged 59 hospital days during the first year posttransplant versus 22 days in the control group (P=0.001). A mean of 31 days hospitalization was directly related to CMV disease. Mean total institutional costs, calculated in 1988 Canadian dollars, were 2.5 times higher for patients with CMV disease than for controls ($42,611 vs. $17,309, P=0.001), reflecting predominantly a difference in general ward ($19,988 vs. $7484, P=0.001), hotel ($2508 vs. $927, P=0.001), clinical laboratory ($5420 vs. $2558, P=0.0001), radiology ($1581 vs. $640, P=0.05), and pharmacy ($4916 vs. $1782, P=0.01) costs and utilization. Operating room, special ward, ancillary, and mean per diem costs ($719 vs. $790, P=NS) were not significantly different between the two groups. Functional graft survival at 1 year was 72% in patients with CMV disease compared with 86% in controls, reducing the mean calculated cost-effectiveness of transplantation by 2.9-fold. These data show that CMV disease has significant economic impact on renal transplantation as a result of extended hospitalization. In order to develop a cost effective management approach to CMV infection, this impact must be considered when assessing therapeutic and prophylactic regimens and protocols of organ allocation.