Cost-effectiveness of dedicated dietitians for hyperphosphatemia management among hemodialysis patients in Lebanon: results from the Nutrition Education for Management of Osteodystrophy trial

Aim: To assess the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients.

Materials and methods: This was a trial-based economic evaluation in 12 Lebanese hospital-based units. In total, 545 prevalent patients were cluster randomized to DD, trained hospital dietitian (THD), and existing practice (EP) groups. During Phase I (6 months), DD (n?=?116) received intensive education by DD trained on renal nutrition, THD (n?=?299) received care from trained hospital dietitians, and EP (n?=?130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months).

Results: At baseline, EP had the lowest weekly hemodialysis time, and DD had the highest serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD: $76.7, $21,007.7; EP: $4.6, $18,675.4; THD: $17.4, $20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and societal costs (DD: –$2,364.0; EP: –$1,727.7; THD: –$1,105.7). At endline, DD experienced the highest decrease in adjusted serum phosphorus (DD: –0.32; EP: +0.16; THD: +0.04?mg/dL), no difference in quality-adjusted life-years (QALY), and the highest societal costs. DD had a cost-effectiveness ratio of $7,853.6 per 1?mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key parameters.

Limitations: The analysis depended on numerous assumptions. Interpreting the results is limited by the significant baseline differences in key parameters, suggestive of higher baseline societal costs in DD.

Conclusions: DD yielded the greatest effectiveness and decrease in societal costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP, but had a low cost-effectiveness probability compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing the long-term cost-effectiveness of DD, on similar groups, is recommended.     

替考拉宁致血液透析患者心动过缓1例

笔者分析1例血液透析患者予替考拉宁抗革兰阳性菌感染的治疗过程中出现心动过缓的原因,从而提醒血液透析患者在使用替考拉宁期间应密切监测心率,以使临床用药更加安全、有效、合理。     

A societal cost-of-illness study of hemodialysis in Lebanon

Aim: Renal failure is a growing public health problem, and is mainly treated by hemodialysis. This study aims to estimate the societal costs of hemodialysis in Lebanon.

Methods: This was a quantitative, cross-sectional cost-of-illness study conducted alongside the Nutrition Education for Management of Osteodystrophy trial. Costs were assessed with a prevalence-based, bottom-up approach, for the period of June–December 2011. The data of 114 patients recruited from six hospital-based units were collected through a questionnaire measuring healthcare costs, costs to patients and family, and costs in other sectors. Recall data were used for the base-case analysis. Sensitivity analyses employing various sources of resources use and costs were performed. Costs were uprated to 2015US$. Multiple linear regression was conducted to explore the predictors of societal costs.

Results: The mean 6-month societal costs were estimated at $9,258.39. The larger part was attributable to healthcare costs (91.7%), while costs to patient and family and costs in other sectors poorly contributed to the total costs (4.2% and 4.1%, respectively). In general, results were robust to sensitivity analyses. Using the maximum value for hospitalization resulted in the biggest difference (+15.5% of the base-case result). Female gender, being widowed/divorced, having hypertension comorbidity, and higher weekly time on dialysis were significantly associated with greater societal costs.

Limitations: Information regarding resource consumption and cost were not readily available. Rather, they were obtained from a variety of sources, with each having its own strengths and limitations.

Conclusion: Hemodialysis represents a high societal burden in Lebanon. Using extrapolation, its total annual cost for the Lebanese society is estimated at $61,105,374 and the mean total annual cost ($18,516.7) is 43.70% higher than the gross domestic product per capita forecast for 2015. Measures to reduce the economic burden of hemodialysis should be taken, by promoting chronic kidney disease’s prevention and encouraging transplantation.     

持续护理模式对缓解透析患者心理压力的作用

目的探讨持续护理模式在血液透析患者中的应用及其在缓解患者抑郁、焦虑、高压等负面情绪方面的作用。方法随机抽取在我院治疗的36位患者为研究对象,运用抑郁焦虑压力量表（DASS-21）采集信息。结果持续护理模式的应用与 DASS-21量表的数据之间有重要关系。应用持续护理模式前后患者抑郁、焦虑、压力等负面情绪得到显著改善。结论持续护理模式可有效缓解血液透析患者的抑郁、焦虑、高压等负面情绪和心理压力,利于患者恢复健康,值得临床应用推广。     

肾康注射液联合重组人促红素对慢性肾衰竭透析患者血清血红蛋白、白蛋白水平的影响

目的 探讨肾康注射液联合重组人促红素对慢性肾衰竭透析患者血清血红蛋白(HBG)、白蛋白(ALB)水平的影响.方法 选取2018年6月至2019年12月湛江中心人民医院收治的70例慢性肾衰竭患者,随机分为对照组与观察组,各35例.对照组应用重组人促红素治疗方案,观察组在此基础上加用肾康注射液治疗,比较两组治疗效果、治疗前...     

健康教育对血液透析患者生存质量的影响

目的探讨健康教育对血液透析患者生存质量的影响。方法抽取本中心新加入规律血液透析患者共52例,随机分成两组,观察组和对照组各26例。对照组进行常规护理;观察组在对照组基础上实施健康教育护理干预,随访观察12个月后,对比两组患者的营养状况、心理情绪、社会角色、运动等生活质量相关指标的变化。结果观察组接受系统的健康教育后营养状况、心理健康、社会角色等各项相关生存质量有明显改善,差异均有统计学意义（均P〈0.05）。结论全面系统的健康教育,可明显提高规律血液透析患者的生存质量。     

血液透析患者诱导期的护理

目的 帮助患者走出漫长透析的第一步.方法 包括心理护理,血管通路的护理,饮食指导提高患者的自我护 理能力.结果 帮助患者平稳、安全的过渡到规律透析阶段.结论 经过护理人员诱导期的护理干预后,大多数患者能 平稳地过渡到规律性透析阶段,基本能生活自理,参加一些力所能及的工作与社交活动.