Health Economic Evaluation For Chronic Kidney Disease Treatment

[Objective]This study aims at health economics evaluation of disease burden in patients with chronic kidney disease and the effect of different treatments on health economics,exploring the gaps and problems in the medical security of chronic kidney disease,and building and improving the medical insurance management strategy of chronic kidney disease on this basis, and put forward policy recommendations to help reduce the economic burden of patients with chronic kidney disease, improve the quality of life of patients in the last.[Method](1)Literature analysis:Through the website of CNKI, VIP, Wanfang, MEDLINE,PubMed and other databases, reading national health and Family Planning Commission, Hubei Province health and Family Planning Commission, National Bureau of statistics institutions and consulting relevant books collected at home and abroad about chronic kidney disease epidemiology, medical insurance status related literature and statistical data, to understand the disease burden of Chinese patients with chronic kidney disease, medical security system existing gaps and problems.(2)Expert consultation method:Through the discussion of kidney internal medicine specialist, pharmaceutical experts, health management experts in the field, health care experts, understanding currently the latest advances in the prevention of chronic kidney disease, medical security level, the level of protection and other security situation and the existing problems and the treatment of chronic renal disease, delay the progression of chronic renal diseases such as to consult the experts.(3)Spot investigation method:A total of 531 inpatients and 300 outpatients and inpatients in 6 hospitals in Wuhan were investigated. Through the knowledge of the half structure interview, questionnaire investigation, etc., to understand the patient'sburden of disease and the current medical security and the demands of patients with the existing problems and deficiencies.(4)Statistical method: the single factor analysis method and logistic regression analysis in patients with chronic kidney disease outpatient expenses and hospitalization expenses and influencing factors, quality of life, the influence factor and so on; using Kaplan Meier survival analysis, analysis of less difference of the survival time of patients with chronic nephropathy in medical security system; using Cox proportional hazard regression model analysis of chronic kidney disease survival time is affected by many factors.(5)Health economics methods: cost utility analysis based on Markov model and analysis of chronic renal dialysis patients with renal replacement therapy(peritoneal dialysis, hemodialysis and renal transplantation) into- utility and the resulting effects of health economics.[Results](a) The epidemiology of chronic kidney disease and the current situation of medical insuranceThe chronic kidney disease incidence shows a rising trend, the incidence showed the trend of younger, North and southwest area of chronic kidney disease prevalence rate and other regions is higher; and chronic kidney disease factors independently associated with include age, hypertension, diabetes, cardiovascular disease, living area and economy etc..China's current health insurance policies for chronic kidney disease mainly exist the following deficiencies: first, the current health insurance policy and clinical practice guidelines do not match. Two is due to the slow update of our health insurance directory, a lot of good efficacy of new drugs into the health care process is slow.(b)Study on the cost burden of chronic kidney diseaseThrough the collected outpatient and hospitalization expenses of single factorcorrelation analysis and multiple factor Logistic regression analysis. The results show that the type of health insurance and whether dialysis is an important factor affecting the cost of hospitalization, medical insurance type and taking drugs is the important factors affecting outpatient expenses.(c) The higher the degree of medical care, the better the quality of life, the longer the survival timeThrough the evaluation of quality of life in patients with chronic kidney disease(CKD) analysis that dialysis and medical security level is an important factor of influencing the quality of life in patients with nephropathy, is the higher level of protection, quality of life was better; according to the log rank test results can see,urban medical insurance patients survival curve is higher than that of the new rural cooperative medical care system, according to the Cox proportional hazards regression model, the more the higher the level of education, the level of medical insurance patients, the survival time longer.(d) peritoneal dialysis is a more cost effective dialysis treatment program.Through the end of end stage renal disease patients with two dialysis treatment program(hemodialysis and peritoneal dialysis) for queue based Markov model analysis, it is found that the blood dialysis mean cumulative cost for 383399 yuan,average cumulative utility was 4.24 QALYs; peritoneal dialysis treatment the average cumulative cost is 3894590 yuan, average cumulative utility was 5.74 QALYs; further for Monte Carlo simulation analysis found that peritoneal dialysis treatment cost-benefit due to hemodialysis.[Conclusion](1)chronic kidney disease early epidemiological monitoring is not enough;(2)low protein diet + acid(Kai Tong) is an important factor in the process of slow nephropathy;(3)the higher the degree of medical care, the better the quality of life, the longerthe survival time;(4) peritoneal dialysis treatment is more cost effective dialysis treatment plan.