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Titolo Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients
Autore Luciana Scalone1,2, Francesca Borghetti1,2, Giuliano Brunori3, Battista Fabio Viola3, Barbara Brancati4, Laura Sottini3, Lorenzo Giovanni Mantovani2,4 and Giovanni Cancarini3 - 1Center for Health Technology Assessment and Outcomes Research, University of Milan, Milan, Italy, 2CHARTA Foundation, Milan, Italy, 3Section of Nephrology, University of Brescia and Division of Nephrology, A.O. Spedali Civili di Brescia, Brescia, Italy and 4CIRFF-Centre of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
Referenza Nephrol Dial Transplant 2009; doi: 10.1093/ndt/gfp572
Contenuto Background: Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD). Methods: An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged ≥70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean ?/patient (patient-year). Results: The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 ?/patient in the first, 6500 ?/patient in the second and 682 ?/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in aworst-case hypothesis. Conclusion: The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.
Data 19.12.2009
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