期刊
MEDICAL DECISION MAKING
卷 26, 期 5, 页码 535-549出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/0272989X06290488
关键词
chronic kidney disease; cost-effectiveness analysis; dialysis; computer simulation; Monte Carlo method
资金
- NIDDK NIH HHS [R01 DK58411] Funding Source: Medline
Background. Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. Methods. We developed a simulation model of individuals progressing towards ESRD and requiring, dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. Results. Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness' we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. Conclusion. The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.
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