| Research purpose and meaning: In this study,we investigated the quality of life of nephrosis patients with two different blood purification methods before and after half a year treatment,to understand the changes of the quality of life of the patients with two blood purification methods,and to explore the influencing factors of the quality of life of the patients with renal disease.At the same time,the disease economic burden of two blood purification methods was investigated,and the cost-effectiveness analysis was carried out to provide reference basis for the clinical choice of more economical blood purification therapy.Methods: From September 2017 to November 2018,the hemodialysis room of the affiliated hospital of a medical university was selected as the subject of study.Under the informed consent of the patient,the eligible patients were paired according to the sex and course of the course,and were assigned to the hemodialysis filtration group(HDF group)and the high-throughput hemodialysis group(HFHD group),in which 72 patients of the hemodialysis filtration group,72 of the high-throughput hemodialysis group,144 of the total,It was investigated by a questionnaire.The questionnaire consists of two parts: the first part adopts the quality of life quality of the kidney disease(KDQOL-SF)to obtain the quality of life of the patient,and the time interval of all the survey objects is 6 months before and after the two-time questionnaire,which is used for measuring the value of the health utility value;and the second part adopts the self-designed questionnaire,The direct non-medical expense and the indirect economic burden of the patient during the blood purification are investigated,and the direct medical expenses come from the data of the in-hospital medical insurance department,which is the economic burden of the disease,and the cost utility analysis is carried out.The database was established using Epidata3.1,and the data collected in the questionnaire were entered.Using the Sss17.0 to analyze the data,the single-factor analysis of the quality of the patientundefineds life and the stepwise regression analysis of the multiple factors,and the non-parametric rank and the test analysis of the economic burden of the patientundefineds disease were carried out.Results:1.After half a year of blood purification treatment,the quality of life of the patients has been improved.The mean score of quality of life in hemodialysis filtration group was 51.78 ±25.15,and that in high flux hemodialysis group was 50.69 ±27.36,50.69 ±27.36,and 50.69 ±27.36,50.69 ±27.36,50.69 ±27.36,50.69 ±27.36 respectively.There was no significant difference in the total score of quality of life(p > 0.05).After half a year of treatment,the mean score of quality of life in hemodialysis filtration group was 54.52 ±31.17,the increment was 1.77 ±17.33,and the average score of high flux hemodialysis group was 53.56 ±15.48,2.87 ±12.37,respectively.The quality of life(QOL)in the total score and physiological function of(RP),physical pain(BP),mental health,(MH),symptom,(SPL),nephropathy in the two groups affected the quality of social interaction in(EKD),(QS1).There was significant difference in the increment of sleep(SQ)dimension(p < 0.05),but there was significant difference in the burden of(BKD),social support(SS)dimension caused by physiological function(PF),nephropathy(p < 0.01).2.The value-added of the quality of life after half a year of treatment with different demographic characteristics of blood-purified renal disease showed that:(1)the value-added value of the life quality of male and female patients was 1.95±6.88 and 1.65±5.63,respectively,and the value-added of the maleundefineds life quality was more than that of the female.The value of life quality of male and female patients was statistically significant(p <0.05),(2)the value of life quality of the patients in the group was 12.38 and 6.96,and the value of life quality of the patients in the 70-year-old group was the smallest,which was-12.91±11.26,and the trend of negative growth was negative.The value-added value of life quality of the patients with different age group decreased,and the value-added difference of the total score of life quality of the patients with different age group had statistical significance(p <0.01),(3)the value-added value of life quality of the patients in the urban and rural workers insurance group was the largest,and the value was 7.92±9.64;At the same time,the value-added value of the life quality of the patients in the self-paid group was the smallest,which was 2.85±6.77,and the difference of the value-added value of the life quantity of the patients with different medical insurance methods was statistically significant(p <0.01).(4)the value-added value of the life quality of the patients with blood purification time less than 6 months was the largest,10.34±15.78,and the value-added of the life quality of the patients in the 3-10-year group and the 10-year-old group was negative,and the value-added of the life quality of the patients in the 10-year group was the lowest,and the value was-5.68±7.05,And the value-added difference of the total score of the life quality of each group was statistically significant(p <0.01).The results of multivariate regression analysis showed that the quality of life of patients with blood purification was significantly influenced by the way of blood purification,the duration of dialysis,gender,age and medical insurance.3.The economic burden of hemodiafiltration patients was 168428 yuan per person,of which the direct economic burden was 103038 yuan per person,including 99598 yuan per person for direct medical expenses,3440 yuan per person for direct non-medical expenses and 65390 yuan per person for indirect diseases.The economic burden of high-throughput hemodialysis patients was 172470 yuan / person,of which the direct economic burden was 107780 yuan per person,including 104509 yuan per person for direct medical expenses,3271 yuan per person for direct non-medical expenses and 64690 yuan per person for indirect diseases.4.Taking the quality of life summary table(KDQOL-SFTM)as the standard,the utility value was 0.462 ±0.137 in the hemodiafiltration group and 0.139 ±0.202 in the half-year treatment group,and the effective value was 0.462 ±0.137 in the hemodiafiltration group and 0.139 ±0.202 in the half-year treatment group.The effective value of quality of life(QOL)was 0.449 ±0.159 in high-throughput hemodialysis group,and the effective value(? U)was 0.200 ±0.233 in half-year treatment.The cost of obtaining a complete QALY in the hemodiafiltration group was 1211712 yuan,and that in the high-flux hemodialysis group was 862350 yuan per complete QALY.Therefore,the effective use of the high-flux hemodialysis component was superior to that of the hemodiafiltration group.Conclusions:1.Both hemodiafiltration and high-flux hemodialysis could improve the quality of life of the patients,and the improvement of the quality of life in high-flux hemodialysis was more significant than that in high-flux hemodialysis.2.Blood purification mode,dialysis duration,gender,age and medical insurance are the main factors that affect the quality of life of patients with blood purification nephropathy.3.The cost-effectiveness analysis showed that the high-throughput hemodialysis group was superior to the hemodiafiltration group.Therefore,high-flux hemodialysis is preferred for patients who apply high-throughput hemodialysis.4.The economic burden of blood purification patients is heavy,with direct medical expenses accounting for more than 60%.With the development of economy,the capital investment for different medical insurance modes should be appropriately increased to increase the reimbursement ratio and expand the reimbursement scope.We will adjust and improve the relevant health insurance policies,integrate the three insurances,and reduce the economic burden on all kinds of patients. |
PDF Full Text Request