Türkiye'de Diyaliz ve Böbrek Transplantasyonu Tedavisinin Maliyet Etkililik Analizi - Cost-Effectiveness Analysis of Dialysis and Kidney Transplantation Treatment in Turkey

Öz Bu araştırmanın amacı, son dönem böbrek yetmezliği tedavisinde uygulanan hemodiyaliz (HD), periton diyalizi (PD) ve böbrek transplantasyonu (Tx) tedavi yöntemlerinin Sosyal Güvenlik Kurumu (SGK) perspektifinden maliyet etkililiğini ve bu yöntemlerin bütçeden ne kadar kaynak tükettiğini tespit etmektir.. Araştırmada Markov modeli kullanılarak bu tedavi yöntemlerinin maliyeti, yaşam yılı ve kaliteye ayarlanmış yaşam yılı hesaplanmış ve hesaplanan sonuçlara %3 indirgeme yapılmıştır. Çalışmanın kapsadığı zaman dilimi ve iskonto oranının sonuçlara etkisini değerlendirmek için tek yönlü duyarlılık analizi yapılmıştır. Son olarak bu tedavilerin ne kadar kaynak tüketimini tespit etmek için bütçe etki analizi yapılmıştır. Araştırma sonuçlarına göre Markov modelinde belirlenen zaman diliminde hasta başına maliyet HD, PD ve Tx sırasıyla; 305.591-TL, 322.895-TL ve 217.259-TL; QALY değerleri ise HD 6.63, PD 8.02, Tx ise 12.99 olarak saptanmıştır. Araştırmada Markov modelinden elde edilen sonuçlara göre bir yıllık yaşam süresinde HD 36.892 TL/YL, PD 29.921 TL/YL ve Tx 14.401 TL/YL maliyet tespit edilirken QALY başına maliyet ise HD 46.105 TL/QALY, PD 40.274 TL/QALY ve Tx 16.714 TL/QALY olarak hesaplanmıştır. Maliyet etkililik analizi sonucuna göre Tx ile HD karşılaştırıldığında 6.37 QALY ve (-) 88.332 TL ilave maliyet sağlamaktadır. Maliyet etkililik analizinde ICER’ın eşik değerin çok altında olması nedeni ile Tx hem HD, hem de PD göre maliyet etkili olarak bulunmuştur. Markov modelinden elde edilen verilere göre SGK toplam sağlık harcamalarının ise %4.64’ünün RRT yöntemlerine harcandığı tahmin edilmektedir.

Anahtar Kelimeler:

maliyet etkililik analizi, hemodiyaliz, periton diyalizi, böbrek transplantasyonu

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