血液透析与腹膜透析的卫生经济学研究概述

Outline of a health economic study of hemodialysis and peritoneal dialysis

目的 比较血液透析与腹膜透析人群的费用、效果及其影响因素,分析其疾病经济负担,剖析现行医疗保险补偿模式对透析技术的影响,进而为临床合理应用透析技术及透析相关政策的调整和完善提供参考依据。方法 采用回顾性调查方法,对首次透析时间在1995～1998年间的上海市6所医院155例血液透析患者和223例腹膜透析患者的费用和效果进行比较。用多元回归法分析费用的影响因素,用COX回归方法分析死亡风险的影响因素,用Logistic回归法分析生命质量的影响因素。回顾性调查210例存活者的疾病负担。运用政策分析法分析补偿模式对透析技术应用的影响。结果 血液透析与腹膜透析人群的死亡风险、生命质量以及医疗费用并无显著差异,而统计描述差异是由于两类人群透析初始的健康状况不均衡造成的。透析人群疾病伤残程度很高,疾病经济负担沉重,负债透析的现象普遍。结论 医疗保险对腹膜透析与血液透析的费用补偿方式差异,造成血液透析技术的过度利用,进一步加重了各方费用的负担。因此,有必要从筹资、补偿模式、供方医疗行为规范等方面调整和完善透析相关政策。

Objective To compare the expenses bom by the two groups of people respectively undergoing hemodialysis and peritoneal dialysis, the effects of their treatment and the influencing factors, analyze the economic disease burden of the patients, and dissect the influence of the current modes of medical insurance compensations on the use of the technique of dialysis so as to provide basis of reference for the rational clinical use of and the readjustment and perfection of policies related to the technique of dialysis. Methods Using the method of retrospective survey, a comparison was made of the expenses born by 155 cases of hemodialysis patients and 223 cases of peritoneal dialysis patients from 6 hospitals in Shanghai who underwent their first dialysis during the 1995 ~ 1998 period and the effects of their treatment. The influencing factors of expenses, mortality risks, and life quality were analyzed respectively by means of multi-regression, COX regression, and logistic regression. The economic disease burden of 210 survivors was investigated retrospectively. And the influence of compensation modes on the use of the technique of dialysis was studied by means of policy analysis. Results There was no marked difference between the groups respectively undergoing hemodialysis and peritoneal dialysis in mortality risks, life quality or medical expenses. The statistical discrepancies were due to different health conditions of the two groups at the outset of their dialysis treatment. The disability degree of the groups undergoing dialysis was high, their economic disease burden was heavy, and the phenomenon of running into debt due to dialysis treatment was widespread. Conclusion Differences in the modes of medical insurance compensations for hemodialysis and peritoneal dialysis expenses have led to the overuse of the technique of hemodialysis, further intensifying the economic burden of the various parties concerned. Thus, it is necessary to readjust and perfect policies related to dialysis in such aspects as fundraising, compensation modes, and the standardization of the medical behavior of the suppliers.