Health Economics Research Of Autosomal Dominant Polycystic Kidney Disease

Objective: To evaluate the direct economic burden of Autosomal dominant polycystic kidney disease(ADPKD)to the society and demonstrate the Health Economics Benefits of preimplantation genetic testing(PGT)through statistics of the basic information of clinical diagnosis and treatment in patients with ADPKD and the cost of diagnosis and treatment of ADPKD.Methods: Analyze the medical record information in the electronic information system of from a hospital in Shanghai,screening on January 1,2013 to December 31,2018.A total of 90845 cases of clinic patients and 9226 cases of hospitalized patients are divided into ADPKD group,diabetic kidney disease and other kidney disease group.According to CKD Staging criteria,the three groups are divided into six subgroups: G1,G2,G3 a,G3b,G4 and G5 group.According to the level of proteinuria were subdivided into: Urinary protein ++++ group,Urinary protein +++ group,Urinary protein ++ group,Urinary protein + group and Urinary protein negative group.Firstly,compare the basic situation of ADPKD group,diabetic kidney disease group and other nephropathy groups,including the number of patients,sex ratio,age distribution,distribution of departments,annual average number of times per capita,etc.The clinical distribution of ADPKD group with different CKD stages was compared with diabetic kidney disease group and other nephropathy group.Secondly,compare the clinical costs of the three groups of patients,including the drug costs,laboratory costs and examination and treatment costs of outpatient and inpatient patients,as well as the costs of ADPKD patients in different departments.Thirdly,statistically analyze the basic situation of outpatient and inpatient visits of ADPKD patients in different proteinuria level groups,including the number of patients,frequency of visits and direct medical expenses.Finally,based on the details of the medical expenses of a new generation of ADPKD patients prevented by Preimplantation Genetic Testing(PGT),the aforementioned statistical data of medical economics for ADPKD patients are compared.The total medical expenses of ADPKD patients from diagnosis to the end of life were estimated,and the costs of using torvaptan to treat patients with rapid-progression ADPKD were estimated.The cost-effectiveness analysis of PGT intervention,traditional ADPKD treatment and torvaptan treatment was conducted using the decision tree model.Results: The number of outpatient times in the ADPKD group of this medical center(5547/90845,6.10%)is close to that of patients with diabetic nephropathy(5916/90845,6.51%),but the average annual frequency per capita(1.8081)is lower than that of the diabetic kidney disease group(8.7630)and others Patients in the nephropathy group(3.4980).Among the ADPKD patients attending the clinic were equal to men and women(men/women outpatients 1.08,men/women inpatients 0.96).The age distribution of outpatients(56.02%)and inpatients(53.45%)were mainly in the 30-60 years old range,and patients under 30 years old is less.The main population of patients with ADPKD in clinical times is CKD stage 5 patients.The distribution of clinics covers almost all clinical departments.The top three in the average annual hospitalization frequency are:Nephrology(562 times/y),Kidney Transplantation(43 times/y)and Urology(25 times/y).They are clinical departments related to renal performance.I IIn the process of comparing the clinical costs of ADPKD with diabetic nephropathy and other renal diseases,it was found that the average cost of outpatient ADPKD patients(1571 yuan/time)was higher than that of diabetic nephropathy patients(556 yuan/time),and the cost of medicines accounted for a relatively high proportion(54.57%).The cost of inpatient ADPKD treatment(12049 yuan/time)was lower than that of the diabetic kidney disease group(19992 yuan /time),and the proportion of operating examination expenses(5034/12049,41.78%)was higher than that of outpatients(542/1571,34.50%).Among the subgroups of ADPKD patients with different stages,the per capita medical expenses of hospitalized patients at stage 3B(30ml·min-1· 1.73m-2 < EGFR < 45ml·min-1· 1.73m-2)were relatively higher(12,813 yuan/time).Although the frequency of times was higher in clinical departments related to kidney,the average cost of intracranial complication-related brain surgery department(RMB 2,609/time)and interventional ultrasound treatment department related to cyst hemorrhage and infection(RMB 4,192/ time)was more prominent.Patients were divided into six different subgroups according to chronic kidney disease stages,and the clinical expenses of ADPKD patients with different renal function levels were compared.It was found that there was no significant difference in the per capita expenses of patients with CKD stage 1-4,while the expenses of patients with end-stage renal disease were significantly higher than before.The average medical cost of patients with polycystic kidney disease was similar to that of patients with diabetic nephropathy.However,due to the higher average annual consultation frequency per capita,the per capita burden of ADPKD was higher than that of patients with diabetic nephropathy from the perspective of the total cost per capita.After grouping and comparing ADPKD patients according to the levels of urinary protein,it was found that ADPKD patients with proteinuria were not uncommon in clinic(49.59% outpatient and 65.47% inpatient),which was higher than the proportion in previous studies.ADPKD patients with proteinuria above ++++ had higher average annual frequency and average medical expenses,suggesting that there were other glomerular diseases.The average cost per time in ADPKD patients increased gradually with the aggravation of urinary protein,especially in outpatient patients,suggesting that the increase of urinary protein in ADPKD patients may indirectly reflect the degree of renal tubular injury,and thus has practical significance for the prediction of disease progression.ADPKD patients with proteinuria were common clinically.ADPKD patients with proteinuria above ++++ had higher frequency and cost per time,suggesting that there were other glomerular diseases.The average cost per time in ADPKD patients increased gradually with the aggravation of urinary protein,especially in outpatient patients,suggesting that the increase of urinary protein in ADPKD patients may indirectly reflect the degree of renal tubular injury,and thus has practical significance for the prediction of disease progression.Estimation using PGT technology to block the next generation of ADPKD patients with reproductive health care costs,and the use of the existing means of diagnosis and treatment ADPKD patients from diagnosis to the health spending at the end of life,the decision tree model and cost-effectiveness analysis suggested that blocking ADPKD by PGT was a better option.Torvaptan showed no significant advantage in cost-effectiveness analysis of rapid-progression ADPKD,but showed a greater advantage in univariate sensitivity analysis.Conclusion: As the fourth cause of end-stage renal disease,the average medical expenditure burden of ADPKD patients was similar to that of diabetic nephropathy patients.The economic cost of disease to individuals and to society cannot be ignored.Based on cost-utility analysis,the medical economic benefits of stopping the emergence of new ADPKD patients with PGT are significantly higher than the medical resource consumption of patients with ADPKD,and more medical resources should be invested to support the further improvement and promotion of this technology.