Abstract：
UNASSIGNED: The increasing prevalence of end-stage renal disease (ESRD) in the United States (US) represents a considerable economic burden due to the high cost of dialysis treatment. This review examines data from real-world studies to identify cost drivers and explore areas where dialysis costs could be reduced.
UNASSIGNED: We identified and synthesized evidence published from 2016-2023 reporting direct dialysis costs in adult US patients from a comprehensive literature search of MEDLINE, Embase, and grey literature sources (e.g. US Renal Data System reports).
UNASSIGNED: Most identified data related to Medicare expenditures. Overall Medicare spending in 2020 was $29B for hemodialysis and $2.8B for peritoneal dialysis (PD). Dialysis costs accounted for almost 80% of total Medicare expenditures on ESRD beneficiaries. Private insurance payers consistently pay more for dialysis; for example, per person per month spending by private insurers on outpatient dialysis was estimated at $10,149 compared with Medicare spending of $3,364. Dialysis costs were higher in specific high-risk patient groups (e.g. type 2 diabetes, hepatitis C). Spending on hemodialysis was higher than on PD, but the gap in spending between PD and hemodialysis is closing. Vascular access costs accounted for a substantial proportion of dialysis costs.
UNASSIGNED: Insufficient detail in the identified studies, especially related to outpatient costs, limits opportunities to identify key drivers. Differences between the studies in methods of measuring dialysis costs make generalization of these results difficult.
UNASSIGNED: These findings indicate that prevention of or delay in progression to ESRD could have considerable cost savings for Medicare and private payers, particularly in patients with high-risk conditions such as type 2 diabetes. More efficient use of resources is needed, including low-cost medication, to improve clinical outcomes and lower overall costs, especially in high-risk groups. Widening access to PD where it is safe and appropriate may help to reduce dialysis costs.
Previous papers have studied the cost of treating patients who need dialysis for kidney failure. We reviewed these costs and looked for patterns. Dialysis was the most expensive part of treatment for people with kidney disease who have Medicare. Dialysis with private insurance was much more expensive than with Medicare. People with diabetes experienced higher costs of dialysis than those without diabetes. Dialysis in a hospital costs more than dialysis at home. There are opportunities to reduce the cost of dialysis that should be explored further, such as more use of low-cost medication that can prevent the worsening of kidney disease and reduce the need for dialysis.
UNASSIGNED: We identified and synthesized evidence published from 2016-2023 reporting direct dialysis costs in adult US patients from a comprehensive literature search of MEDLINE, Embase, and grey literature sources (e.g. US Renal Data System reports).
UNASSIGNED: Most identified data related to Medicare expenditures. Overall Medicare spending in 2020 was $29B for hemodialysis and $2.8B for peritoneal dialysis (PD). Dialysis costs accounted for almost 80% of total Medicare expenditures on ESRD beneficiaries. Private insurance payers consistently pay more for dialysis; for example, per person per month spending by private insurers on outpatient dialysis was estimated at $10,149 compared with Medicare spending of $3,364. Dialysis costs were higher in specific high-risk patient groups (e.g. type 2 diabetes, hepatitis C). Spending on hemodialysis was higher than on PD, but the gap in spending between PD and hemodialysis is closing. Vascular access costs accounted for a substantial proportion of dialysis costs.
UNASSIGNED: Insufficient detail in the identified studies, especially related to outpatient costs, limits opportunities to identify key drivers. Differences between the studies in methods of measuring dialysis costs make generalization of these results difficult.
UNASSIGNED: These findings indicate that prevention of or delay in progression to ESRD could have considerable cost savings for Medicare and private payers, particularly in patients with high-risk conditions such as type 2 diabetes. More efficient use of resources is needed, including low-cost medication, to improve clinical outcomes and lower overall costs, especially in high-risk groups. Widening access to PD where it is safe and appropriate may help to reduce dialysis costs.
Previous papers have studied the cost of treating patients who need dialysis for kidney failure. We reviewed these costs and looked for patterns. Dialysis was the most expensive part of treatment for people with kidney disease who have Medicare. Dialysis with private insurance was much more expensive than with Medicare. People with diabetes experienced higher costs of dialysis than those without diabetes. Dialysis in a hospital costs more than dialysis at home. There are opportunities to reduce the cost of dialysis that should be explored further, such as more use of low-cost medication that can prevent the worsening of kidney disease and reduce the need for dialysis.
摘要：
由于透析治疗的高成本,在美国(US),终末期肾病(ESRD)的患病率增加代表了相当大的经济负担。这篇综述研究了来自现实世界研究的数据，以确定成本驱动因素并探索可以降低透析成本的领域。
■我们从MEDLINE的全面文献检索中确定并综合了2016-2023年发布的报告美国成年患者直接透析费用的证据，Embase,和灰色文献来源(例如，美国肾脏数据系统报告)。
■与医疗保险支出相关的大多数识别数据。2020年的总体医疗保险支出为29B用于血液透析，28亿美元用于腹膜透析（PD）。透析费用占ESRD受益人医疗保险总支出的近80%。私人保险付款人一贯为透析支付更多费用；例如，私人保险公司在门诊透析上的每人每月支出估计为10,149美元，而Medicare支出为3,364美元。特定高危患者组的透析费用较高(例如，2型糖尿病,丙型肝炎）。血液透析的支出高于PD，但是PD和血液透析之间的支出差距正在缩小。血管通路费用占透析费用的很大比例。
■确定的研究细节不足，特别是与门诊费用有关，限制了确定关键驱动因素的机会。测量透析成本的方法研究之间的差异使这些结果的概括变得困难。
■这些研究结果表明，预防或延迟发展到ESRD可以为医疗保险和私人付款人节省大量成本，特别是在2型糖尿病等高风险患者中。需要更有效地利用资源，包括低成本的药物治疗,为了改善临床结果和降低总成本，尤其是高危人群。在安全和适当的地方扩大对PD的访问可能有助于降低透析成本。
以前的论文研究了肾衰竭需要透析的患者的治疗费用。我们审查了这些成本并寻找模式。透析是治疗患有肾脏疾病的人最昂贵的部分。使用私人保险进行透析比使用Medicare要昂贵得多。糖尿病患者的透析费用高于无糖尿病患者。在医院透析比在家里透析花费更多。有机会降低透析费用，应该进一步探索，例如，更多使用可以防止肾脏疾病恶化并减少透析需求的低成本药物。
■我们从MEDLINE的全面文献检索中确定并综合了2016-2023年发布的报告美国成年患者直接透析费用的证据，Embase,和灰色文献来源(例如，美国肾脏数据系统报告)。
■与医疗保险支出相关的大多数识别数据。2020年的总体医疗保险支出为29B用于血液透析，28亿美元用于腹膜透析（PD）。透析费用占ESRD受益人医疗保险总支出的近80%。私人保险付款人一贯为透析支付更多费用；例如，私人保险公司在门诊透析上的每人每月支出估计为10,149美元，而Medicare支出为3,364美元。特定高危患者组的透析费用较高(例如，2型糖尿病,丙型肝炎）。血液透析的支出高于PD，但是PD和血液透析之间的支出差距正在缩小。血管通路费用占透析费用的很大比例。
■确定的研究细节不足，特别是与门诊费用有关，限制了确定关键驱动因素的机会。测量透析成本的方法研究之间的差异使这些结果的概括变得困难。
■这些研究结果表明，预防或延迟发展到ESRD可以为医疗保险和私人付款人节省大量成本，特别是在2型糖尿病等高风险患者中。需要更有效地利用资源，包括低成本的药物治疗,为了改善临床结果和降低总成本，尤其是高危人群。在安全和适当的地方扩大对PD的访问可能有助于降低透析成本。
以前的论文研究了肾衰竭需要透析的患者的治疗费用。我们审查了这些成本并寻找模式。透析是治疗患有肾脏疾病的人最昂贵的部分。使用私人保险进行透析比使用Medicare要昂贵得多。糖尿病患者的透析费用高于无糖尿病患者。在医院透析比在家里透析花费更多。有机会降低透析费用，应该进一步探索，例如，更多使用可以防止肾脏疾病恶化并减少透析需求的低成本药物。
