Economic evaluation of medical care of patients with end-stage dialysis-dependent renal disease

Aim: economic analysis of the efficiency of medical care of patients with the end-stage renal disease (ESRD) with peritoneal (PD) or hemodialysis (HD), based on a decision analysis model. Methods: the research is based on the methods impact analysis of value for money and Russian federal budget efficiency taking into account prices for dialysis according to the methodical recommendations and rules of the compulsory health insurance (CHI) and current tariffs in six regions of Russian Federation. The budget impact analysis showed that the expansion of the PD program used as the first-line therapy in patients with ESRD is accompanied by savings in public budget 809028021 rubles for the treatment of 28440 patients per year. The overall cost of PD therapy was by 66157 rubles (2%) per a patient lower than the cost of HD therapy. The use of PD in the regions according to the current rates is accompanied by budget savings from 3759929 rubles in the Orenburg region (452 dialysis patients) to 615749884 rubles a year in the Krasnodar region (1837 dialysis patients). Conclusion: the budget impact analysis shows that the use of PD therapy is accompanied by economy of budget funds, as based on rates for carrying out dialysis, established according to methodical recommendations about payment methods of medical care supported by CHI and at the current regional tariffs. It is found that PD in comparison with HD is preferable medical technology from a position of the value for money for current regional tariffs and at the federal rates recommended by CHI.

терминальная почечная недостаточность, перитонеальный диализ, гемодиализ, фармакоэкономический анализ, анализ "влияния на бюджет", анализ "затраты-полезность", peritoneal dialysis, hemodialysis, economic analysis, budget impact analysis, cost-utility analysis

1. Бикбов Б. Т., Томилина Н. А. Заместительная терапия больных с хронической почечной недостаточностью в Российской Федерации в 1998-2013 гг. Нефрология и диализ. 2015. Т.17. №3: 5-107.

2. Государственный реестр предельных отпускных цен производителей на лекарственные препараты, включенные в перечень жизненно необходимых и важнейших лекарственных препаратов. URL: www.grls.rosminzdrav.ru

3. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. А.В. Смирнов и др. 2012. С. 51.

4. Пенсионный фонд Российской Федерации URL: www.pfrf.ru

5. Письмо МЗ РФ от 22.12.2016 № 11-8/10/2-8266 и ФОМС от 22.12.2016 12578/26/и "О методических рекомендациях по способам оплаты медицинской помощи за счет средств обязательного медицинского страхования"

6. Поиск лекарственных препаратов в России Аптечка.ру URL: http://aptechka.ru/

7. Постановления Правительства Российской Федерации от 19.12.2016 г. № 1403 "О Программе государственных гарантий бесплатного оказания гражданам медицинской помощи на 2017 год и плановый период 2018 и 2019 годов".

8. Приказ от 20 декабря 2012 г. N 1268н "Об утверждении стандарта специализированной медицинской помощи при хронической болезни почек 5 стадии в преддиализном периоде, при госпитализации с целью подготовки к заместительной почечной терапии".

9. Федеральная служба государственной статистики URL: http://www.gks.ru/

10. Ягудина Р.И., Серпик В.Г., Сороковиков И.В. Методологические основы анализа "затраты-эффективность". Фармакоэкономика: теория и практика. 2014. 2. №2: 23-26.

11. Ягудина Р.И., Серпик В.Г., Угрехелидзе Д.Т. Методологические основы анализа "влияния на бюджет". Фармакоэкономика: теория и практика. 2015. 3. №4: 5-8.

12. Al-Hwiesh A. K. et al. Percutaneous versus laparoscopic placement of peritoneal dialysis catheters: Simplicity and favorable outcome. Saudi Journal of Kidney Diseases and Transplantation. 2014. 25. №. 6: 1194.

13. Barone R. J. et al. Peritoneal Dialysis as a First versus Second Option after Previous Haemodialysis: A Very Long-Term Assessment. International journal of nephrology. 2014: 234-237.

14. Hauch A. T., Lundberg P. W., Paramesh A. S. Laparoscopic Techniques Enable Peritoneal Dialysis in the Difficult Abdomen. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2014. 18: 4.

15. Julius M. et al. A comparison of employment rates of patients treated with continuous ambulatory peritoneal dialysis vs in-center hemodialysis (Michigan End-Stage Renal Disease Study). Archives of internal medicine. 1989. 149. №. 4: 839-842.

16. Liyanage T. et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet. 2015. 385. №. 9981: 1975-1982.

17. Orlando L. A. et al. The chronic kidney disease model: a general purpose model of disease progression and treatment. BMC medical informatics and decision making. 2011. 11. №. 1: 41.

18. Ouyang C. J. et al. Comparing the incidence of catheter-related complications with straight and coiled tenckhoff catheters in peritoneal dialysis patients-a single-center prospective randomized trial. Peritoneal Dialysis International. 2015. 35. №. 4: 443-449.

19. Restrepo C. A., Buitrago C. A., Holguin C. Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons. International journal of nephrology and renovascular disease. 2014. 7: 383.

20. Rutkowski B. Highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe. Nephrol. Dial. Transplant. 2006. 21: 4-10.

21. Sennfalt K., Magnusson М., Carlsson Р. Comparison of hemodialysis and peritoneal dialysis--a cost-utility analysis. Peritoneal Dialysis International. 2002. 22. №. 1: 39-47.

22. US. Renal Data System. USRDS 2016 Annual data Report: Atlas of end-stage renal disease in the Unites States. 2016.

23. Zhang A. H. et al. Comparison of quality of life and causes of hospitalization between hemodialysis and peritoneal dialysis patients in China. Health Qual Life Outcomes. 2007. 5. №. 1: 49.