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2.
Medicine (Baltimore) ; 98(33): e16808, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415394

RESUMO

Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.


Assuntos
Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Nefrologia/economia , Diálise Renal/economia , Insuficiência Renal Crônica/economia , Idoso , Assistência à Saúde/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/economia , Encaminhamento e Consulta/economia , Estudos Retrospectivos
3.
PLoS One ; 14(6): e0211604, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31242189

RESUMO

OBJECTIVE: EQ-5D-3L is a generic QOL tool used mainly in economic evaluations. Burden of Chronic Kidney Disease (CKD) is rising in Sri Lanka. Assessing the validity of generic QOL tools creates new opportunities of their utilization among patients with CKD. METHODS: A cross-sectional study was conducted among 1036 CKD patients, selected using the simple random sampling technique. The validity was tested with six a-priori hypotheses. These included construct validity assessments, evaluating convergent validity and performing known group comparisons. EQ-5D-3L, Short Form-36 (SF-36) were used to assess QOL. Center for Epidemiological Studies Depression Scale (CES-D-20) and General Health Questionnaire-12 (GHQ-12) were used to assess the presence of depression and psychological distress respectively. Internal consistency of the whole tool and when each item is removed was assessed by Cronbach alpha. RESULTS: The response rate was 99.2%. Majority of participants were males (n = 646,62.4%) in the age category of 41-60 (n = 530; 51.2%). Most were in either stage 4 or 5 of CKD (n = 646,75.1%). The summary measures of SF-36, positively and significantly correlated with the EQ-5D-3L index and VAS scores (p<0.001). EQ-5D-3L QOL scores were significantly different between the group with depression and without as measured by CES-D-20 (p<0.001). Assessed using GHQ-12, similar significance was detected between the group with psychological distress and without (p<0.001). The Cronbach alpha was 0.834 and when each item was removed, ranged from 0.782 to 0.832. CONCLUSION: EQ-5D-3L is a valid generic QOL tool with satisfactory internal consistency to be used among CKD patients in the pre-dialysis stage.


Assuntos
Qualidade de Vida/psicologia , Insuficiência Renal Crônica/psicologia , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/etiologia , Diálise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Insuficiência Renal Crônica/economia , Sri Lanka , Adulto Jovem
5.
PLoS One ; 14(5): e0216432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31100069

RESUMO

To investigate how changes in eGFR can affect medical costs, a regional cohort of national health insurance beneficiaries in Japan was developed from a nationwide database system (Kokuho database, KDB), and non-individualized data were obtained. From 105,661 people, subjects on chronic dialysis and subjects without consecutive medical checkups were excluded. Finally, medical costs in the follow-up year categorized by annual changes in eGFR between baseline and the next year were longitudinally examined in 70,627 people ranging in age from 40 to 74 years. Global mean costs for subjects with a rapid decrease in eGFR (≤-30%/year) were the highest among all ΔeGFR categories. In men, the cost was 1.42 times that for a stable eGFR. A total of 6,268 (19.4%) men and 5,381 (14.0%) women with eGFR <60 ml/min/1.73 m2 were identified in the baseline year. The mean cost was higher with a low eGFR than without a low eGFR, and there were also higher proportions newly initiating dialysis in 2014 (low eGFR with rapid decrease in eGFR vs. with stable eGFR: 9.61% vs. 0.02% in women, P<0.001). Moreover, the costs for low eGFR subjects with a rapid decrease in eGFR were more than twice those of non-low eGFR subjects with a rapid decrease in eGFR and also compared to low eGFR subjects with a stable eGFR. Moreover, initiating chronic dialysis was considered one of the major causes of high medical costs in women with rapid eGFR decline. To the best of our knowledge, this is the first study of renal disease using a cohort developed from the KDB system recently established in Japan.


Assuntos
Taxa de Filtração Glomerular , Diálise Renal/economia , Insuficiência Renal Crônica , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Estudos de Coortes , Custos e Análise de Custo , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia
6.
Contrib Nephrol ; 198: 87-93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991413

RESUMO

BACKGROUND: With the growth in the global economy, the number of patients worldwide undergoing renal replacement therapy such as hemodialysis is increasing by 6-7% annually. Accordingly, medical costs for the treatment of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) as well as for renal replacement therapy have become a major issue. SUMMARY: It has been reported that in the United States, the annual medical cost for a patient with CKD is approximately USD 20,000, and that the total medical cost for a CKD patient is higher than that of an ESRD patient [1]. In the present study, we found that the medical costs for renal replacement therapy (RRT) in Japan are reasonable compared to those in the United States and Europe. Key Messages: The medical costs for RRT in Japan are reasonable and are not a major issue in Japan.


Assuntos
Insuficiência Renal Crônica/economia , Progressão da Doença , Europa (Continente) , Custos de Cuidados de Saúde , Humanos , Japão , Diálise Renal/economia , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/economia , Estados Unidos
7.
Artigo em Inglês | MEDLINE | ID: mdl-30836681

RESUMO

Chronic kidney disease (CKD) has been redefined in the new millennium as any alteration of kidney morphology, function, blood, or urine composition lasting for at least 3 months. This broad definition also encompasses diseases or conditions that are associated with normal kidney function, such as a kidney scarring from an acute pyelonephritis episode or a single kidney, as a result of kidney donation. CKD is a relevant public health problem. According to the 2015 Global Burden of Disease Study, it was the 12th leading cause of death, leading to 1.1 million deaths, worldwide, each year. The role of CKD as a cause of death is evident where renal replacement therapy (RRT) is not available, however, its role in increasing death risk is not easily calculated. RRT consumes about 3⁻5% of the global healthcare budget where dialysis is available without restrictions. While the prevalence of CKD is increasing overall as lifespans extend, being linked to diabetes, hypertension, obesity, and atherosclerosis, CKD is at least partly preventable and its effects may be at least partly counterbalanced by early and appropriate care. We will welcome papers on all aspects of CKD, including organization, cost, and models of care. Papers from developing countries will be particularly welcomed.


Assuntos
Bioética , Organizações de Planejamento em Saúde/normas , Assistência de Longa Duração/organização & administração , Insuficiência Renal Crônica/terapia , Organizações de Planejamento em Saúde/tendências , Humanos , Masculino , Diálise Renal/economia , Diálise Renal/ética , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal/economia , Terapia de Substituição Renal/ética
8.
BMC Nephrol ; 20(1): 31, 2019 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704421

RESUMO

BACKGROUND: People with chronic kidney disease (CKD) are at an increased risk of developing hyperkalaemia due to their declining kidney function. In addition, these patients are often required to reduce or discontinue guideline-recommended renin-angiotensin-aldosterone system inhibitor (RAASi) therapy due to increased risk of hyperkalaemia. This original research developed a model to quantify the health and economic benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD. METHODS: A patient-level simulation model was designed to fully characterise the natural history of CKD over a lifetime horizon, and predict the associations between serum potassium levels, RAASi use and long-term outcomes based on published literature. The clinical and economic benefits of maintaining sustained potassium levels and therefore avoiding RAASi discontinuation in CKD patients were demonstrated using illustrative, sensitivity and scenario analyses. RESULTS: Internal and external validation exercises confirmed the predictive capability of the model. Sustained potassium management and ongoing RAASi therapy were associated with longer life expectancy (+ 2.36 years), delayed onset of end stage renal disease (+ 5.4 years), quality-adjusted life-year gains (+ 1.02 QALYs), cost savings (£3135) and associated net monetary benefit (£23,446 at £20,000 per QALY gained) compared to an absence of RAASi to prevent hyperkalaemia. CONCLUSION: This model represents a novel approach to predicting the long-term benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD, irrespective of the strategy used to achieve this target, which may support decision making in healthcare.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Simulação por Computador , Hiperpotassemia/prevenção & controle , Modelos Biológicos , Potássio/sangue , Insuficiência Renal Crônica/complicações , Sistema Renina-Angiotensina/efeitos dos fármacos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Redução de Custos , Progressão da Doença , Feminino , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/economia , Hiperpotassemia/etiologia , Rim/fisiopatologia , Falência Renal Crônica/prevenção & controle , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/terapia
9.
J Med Econ ; 22(5): 447-454, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30736708

RESUMO

AIMS: Examine healthcare costs across chronic kidney disease (CKD) stages for US patients with type 2 diabetes (T2D). MATERIALS AND METHODS: IQVIA Real World Data Adjudicated Claims linked electronic medical records and insurance claims from January 1, 2012 through March 31, 2017 were used for this retrospective study. Adults diagnosed with T2D and comorbid CKD were included. General linear models incorporating splines were constructed, and information from these regressions were used to inform the relationship between medical costs and CKD. Multivariable analyses controlled for patient characteristics, vital signs, general health, prior medication use, prior visit to specialists, index A1c, and year of index date. RESULTS: There were 6,645 individuals who met the study criteria. Results generally indicate sharp increases in annual total medical costs and non-drug medical costs in the 1 year post-period for patients with Stage 4 or 5 CKD (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73 m2) with each 1 point reduction in eGFR from 30 associated with an increase of $1,870 in all-cause total medical costs (p < 0.0001) and $1,805 of all-cause non-drug medical costs (p < 0.0001). Similarly, each point decline below 30 mL/min was associated annual cost increases of $1,701 for CKD-related total medical costs, $1,695 for CKD-related non-drug medical costs, $173 for diabetes-related medical costs, and $187 for diabetes-related non-drug medical costs (all p < 0.0001). LIMITATIONS: The investigation included only patients with medical insurance and laboratory test results, and results may not be generalizable to all T2D patients with CKD. The methodology allowed us to determine associations, not causation, and potential confounders, such as duration of diabetes, diet, exercise, or social support, could not be assessed. CONCLUSIONS: Results indicate there are sharp and significant increases in medical costs among T2D patients with Stage 4 and 5 CKD compared to those with earlier stages of CKD.


Assuntos
Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/epidemiologia , Fatores Etários , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Taxa de Filtração Glomerular , Hemoglobina A Glicada , Recursos em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos
10.
Blood Purif ; 47(1-3): 156-165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30712033

RESUMO

BACKGROUND: Increasing healthcare expenditures have triggered a trend from volume to value by linking patient outcome to costs. This concept first described as value-based healthcare (VBHC) by Michael Porter is especially applicable for chronic conditions. This article aims to explore the applicability of the VBHC framework to the chronic kidney disease (CKD) care area. METHODS: The 4 dimensions of VBHC (measure value; set and communicate value benchmarking; coordinate care; payment to reward value-add) were explored for the CKD care area. Available data was reviewed focusing on CKD initiatives in Europe to assess to what extent each of the 4 dimensions of VBHC have been applied in practice. RESULTS: Translating VBHC into value-based renal care (VBRC) seems to be initiated to a limited extent in European health systems. In most cases not all dimensions of VBHC have been utilized in the renal care initiatives. CONCLUSION: The translation of VBHC into VBRC is possible and even desirable if an optimal treatment pathway for CKD patients could be achieved. This would require an organizational change in health system set up and should include a strategy focusing on full care responsibility. The patient outcome perspective and health economic analysis need to be the centre of attention.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/normas , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/terapia , Custos e Análise de Custo , Assistência à Saúde/métodos , Europa (Continente)
11.
Nephrology (Carlton) ; 24(5): 534-541, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30141833

RESUMO

AIM: We aim to examine difference in incremental direct medical costs between non-progressive and progressive chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) in Singapore. METHODS: This was a prospective study on 676 patients with T2DM attending a diabetes centre in a regional hospital. Annual direct medical costs were extracted from the administrative database. Ordinary least squares regression was used to estimate contribution of CKD progression to annual costs, adjusting for demographics and baseline clinical covariates. RESULTS: Over mean follow-up period of 2.8 ± 0.4 years, 266 (39.3%) had CKD progression. The excess total follow-up medical costs from baseline was S$4243 higher in progressors compared to non-progressors (P = 0.002). The mean cost differential between the two groups increased from S$2799 in Stages G1-G2 to S$11180 in Stage G4. Inpatient cost accounted for 63.4% of total cost of progression. When stratified by glomerular filtration rate stages, the respective total mean annual costs at stages glomerular filtration rate Stages G3a-G3b and G4 were S$3290 (132%; P = 0.001) and S$4416 (135%; P = 0.011) higher post-progression. CONCLUSION: Chronic kidney disease progression in T2DM is associated with high medical costs. The cost of progression is higher with higher severity of CKD stage at baseline and could be largely driven by inpatient admission.


Assuntos
Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/terapia , Custos de Cuidados de Saúde , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/terapia , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Feminino , Custos Hospitalares , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Índice de Gravidade de Doença , Singapura/epidemiologia , Fatores de Tempo
12.
Nephrology (Carlton) ; 24(1): 56-64, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29206319

RESUMO

AIM: Although a National Health Screening Program (NHSP) for chronic kidney disease (CKD) has been implemented in Korea since 2002, its cost-effectiveness has never been determined. This study aimed to estimate the cost-utility of NHSP for CKD in Korea. METHODS: A Markov decision analytic model was constructed to compare CKD screening strategies of the NHSP with no screening. We developed a model that simulated disease progression in a cohort aged 20-120 years or death from the societal perspective. RESULTS: Biannual screening starting at age 40 for CKD by proteinuria (dipstick) and estimated glomerular filtration ratio had an ICUR of $66 874/QALY relative to no screening. The targeted screening strategy had an ICUR of $37 812/QALY and $40 787/QALY for persons with diabetes and hypertension, respectively. ICURs improved with lower cost strategies. The most influential parameter that might make screening more cost-effective was the effectiveness of treatment on CKD to decrease disease progression and mortality. CONCLUSIONS: The Korean NHSP for CKD is more cost-effective for patients with diabetes or hypertension than the general population, consistent with prior studies. Although it is too early to conclude the cost-effectiveness of the Korean NHSP for CKD, this study provides evidence that is useful in evaluating the cost-effectiveness of CKD interventions.


Assuntos
Custos de Cuidados de Saúde , Programas de Rastreamento/economia , Programas Nacionais de Saúde/economia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Simulação por Computador , Análise Custo-Benefício , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Valor Preditivo dos Testes , Prognóstico , Proteinúria/diagnóstico , Proteinúria/economia , Proteinúria/epidemiologia , Proteinúria/terapia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , República da Coreia/epidemiologia , Fatores de Risco , Fatores de Tempo , Urinálise/economia , Adulto Jovem
13.
Eur J Health Econ ; 20(1): 75-82, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29796781

RESUMO

One possible source of hypothetical bias in willingness to pay (WTP) estimates is response uncertainty, referring to subject's uncertainty about the value of the good under assessment. It has been argued that uncertainty can be measured using the post-valuation 'certainty question' that asks: 'How certain are you about your stated WTP?' and marks the degree of certainty on a quantitative or a qualitative scale. Research has shown that the self-reported certainty evaluations can help mitigate hypothetical bias and obtain increasingly accurate WTP estimates. These study reports present a simple test of reliability of post-valuation certainty assessment and then looks at the empirical evidence for clues regarding the general usefulness of certainty adjustment in mitigating hypothetical bias in WTP studies. We find that the post-estimation uncertainty scores are malleable, i.e., significantly correlated with entirely irrelevant information. We conclude that more robust evidence could justify the routine inclusion of certainty evaluation in WTP studies although in the meantime the interpretation of certainty-adjusted WTP values should be approached cautiously.


Assuntos
Viés , Financiamento Pessoal/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/terapia , Fatores Socioeconômicos , Incerteza
14.
J Oncol Pharm Pract ; 25(4): 855-864, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29661050

RESUMO

OBJECTIVES: Within a median 1.2 years after patients have an initial diagnosis with multiple myeloma, up to 61% were diagnosed with renal impairment and 50% were diagnosed with chronic kidney disease. This study estimated economic burden associated with chronic kidney disease in multiple myeloma patients in the US. METHODS: In this retrospective cohort study, patients ≥18 years old with ≥1 inpatient or ≥ 2 outpatient multiple myeloma diagnoses between 1 January 2008 and 31 March 2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. Chronic kidney disease patients had ≥1 diagnosis of chronic kidney disease Stages 1-5 (first chronic kidney disease diagnosis date = index date) on or after the first multiple myeloma diagnosis, and were propensity score matched 1:1 to multiple myeloma patients without chronic kidney disease, end-stage renal disease, dialysis, or other type of chronically impaired renal function. All patients had ≥six-month continuous enrollment prior to index date and were followed for ≥one month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (30 September 2015). The per-patient per-year healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 US dollars. RESULTS: A total of 2541 multiple myeloma patients with chronic kidney disease stages 1-5 and 2541 matched controls met the study criteria and were respectively 69.3 and 69.6 years, 54.5% and 55.3% men, and had 572.2 and 533.4 mean days of follow up. Compared to controls, chronic kidney disease patients had significantly (all P < 0.001) higher proportions (57.1% vs. 32.1%) and frequency (1.2 vs. 0.5) of inpatient admissions, frequency of emergency room visits (5.1 vs. 3.3), and total costs ($106,634 vs. $71,880). Sensitivity analyses found that patients with chronic kidney disease, end-stage renal disease, or dialysis had $78,455 ( P < 0.001) higher costs (per-patient per-year) than matched controls. CONCLUSIONS: The economic burden associated with chronic kidney disease in patients with multiple myeloma was estimated to be between $34,754 and $78,455 per-patient per-year. Given its substantial clinical and economic impact, preservation of renal function is important in multiple myeloma patient care.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Recursos em Saúde , Mieloma Múltiplo/complicações , Insuficiência Renal Crônica/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Estados Unidos
15.
Rev Assoc Med Bras (1992) ; 64(12): 1108-1116, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30569987

RESUMO

OBJECTIVE: The aim of this study is to discuss the global costs attributed to chronic kidney disease (CKD) and its impact on healthcare systems of developing countries, such as Brazil. METHODS: This is a systematic review based on data from PubMed/Medline, using the key words "costs" and "chronic kidney disease", in January 2017. The search was also done in other databases, such as Scielo and Google Scholar, aiming to identify regional studies related to this subject, published in journal not indexed in PubMed. Only papers published from 2012 on were included. Studies on CKD costs and treatment modalities were prioritized. The search resulted in 392 articles, from which 291 were excluded because they were related to other aspects of CKD. From the 101 remaining articles, we have excluded the reviews, comments and study protocols. A total of 37 articles were included, all focusing on global costs related to CKD. RESULTS: Despite methods and analysis were diverse, the results of these studies were unanimous in alerting for the impact (financial and social) of CKD on health systems (public and private) and also on family and society. CONCLUSIONS: To massively invest in prevention and measures to slow CKD progression into its end-stages and, then, avoid the requirement for dialysis and transplant, can represent a huge, and not yet calculated, economy for patients and health systems all over the world.


Assuntos
Efeitos Psicossociais da Doença , Insuficiência Renal Crônica/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Insuficiência Renal Crônica/terapia
16.
PLoS One ; 13(11): e0207960, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30475893

RESUMO

Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Individuals with more severe CKD had lower HRQoL compared to those with better kidney function. Compared to those with normal/low normal kidney function and stage 1 CKD, those with stage 2, stage 3 with albuminuria and stage 4/5 CKD experienced a decrement of 0.11, 0.18 and 0.28 in their utility index, respectively. Applying the UK reimbursement threshold for a QALY, the monetised lifetime burden of reduced HRQoL due to stage 2, stage 3 with albuminuria and stage 4/5 CKD were £103,734; £83,399; £125,335 in males and £143,582; £70,288; £203,804 in females, respectively. Utilizing the predicted prevalence of CKD among individuals with diabetes mellitus, the economic burden of CKD per million of individuals with diabetes is forecasted at approximately £11.4 billion in 2025. In conclusion, CKD has a strong adverse impact on HRQoL in multiple domains. The estimated economic burden of CKD among individuals with diabetes mellitus in the UK is projected to rise markedly over time.


Assuntos
Qualidade de Vida , Insuficiência Renal Crônica/economia , Idoso , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Estudos Transversais , Inglaterra , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença , Fatores Sexuais
17.
Korean J Intern Med ; 33(6): 1160-1168, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30396254

RESUMO

BACKGROUND/AIMS: The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis. METHODS: This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access. RESULTS: The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty. CONCLUSION: The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.


Assuntos
Derivação Arteriovenosa Cirúrgica/economia , Implante de Prótese Vascular/economia , Procedimentos Endovasculares/economia , Custos de Cuidados de Saúde , Complicações Pós-Operatórias/economia , Diálise Renal/economia , Insuficiência Renal Crônica/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/tendências , Prótese Vascular/efeitos adversos , Prótese Vascular/economia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/tendências , Criança , Pré-Escolar , Bases de Dados Factuais , Remoção de Dispositivo/economia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Flebografia/economia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Diálise Renal/efeitos adversos , Diálise Renal/tendências , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , República da Coreia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Saudi J Kidney Dis Transpl ; 29(5): 1188-1191, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30381517

RESUMO

Chronic kidney disease has been observed to be a major threat to the world's health, and in some African countries, it is a death sentence. It affects economically productive young adults between the ages of 20-50 in Sub-Saharan Africa as against the middle age and elderly in the developed world. Challenges of renal care in Africa are numerous among which are equity, accessibility, financial constraint, and lack of workforce to mention a few. Therefore, Africa countries must prioritize renal care and include it in the health agenda to cater for the present and future health need of the people.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Adulto , África ao Sul do Saara/epidemiologia , Idade de Início , Feminino , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/economia , Fatores de Risco , Adulto Jovem
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