Cost estimation and influencing factor analysis of continuous renal replacement therapy_West China Medical Journal

Authors：

SHI Liwei ^1,2 , QIU Yingpeng ^1,2 , XIANG Yang ³ , LIU Kejun ^1,2 ,  XIAO Yue ^1,2

1. China National Health Development Research Center, Beijing 100044, P. R. China;
2. National Center for Medicine and Health Technology Assessment, Beijing 100044, P. R. China;
3. School of Public Health, Dalian Medical University, Liaoning, Dalian 116044, P. R. China;

Corresponding?author：

XIAO Yue, Email: moonxy@126.com

Keywords：

Continuous renal replacement therapy; cost estimation; sensitivity analysis

DOI：

10.7507/1002-0179.202205155

Video：

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Objective To estimate the cost of continuous renal replacement therapy (CRRT) in public hospitals and analyze the main influencing factors of the cost, in order to provide evidence for the optimal application of CRRT technology. Methods In March 2021, activity-based costing was used to estimate and analyze the cost of CRRT, the data of which were collected from 5 hospitals in Jiangsu, Zhejiang, Henan, Sichuan and Xinjiang, and single factor sensitivity analysis was used to find the main influencing factors of the cost. Results The hourly treatment costs of CRRT in the 5 hospitals ranged from 265.30 to 474.44 yuan, with an average of 376.81 yuan. The costs of manpower and filters accounted for the top two largest proportions, the manpower cost of continuous veno-venous hemofiltration and continuous veno-venous hemodiafiltration accounted for 22.90% and 21.51%, respectively, and the filters cost of the two types of CRRT accounted for 15.07% and 17.73%, respectively. The unit cost and cost composition varied greatly between hospitals. There were four factors affecting the unit cost, namely clinical operation, efficiency, price and patient, among which clinical operation difference was the primary factor leading to cost difference. Conclusions The application cost of CRRT technology varies greatly among hospitals, and there are many factors affecting the cost. Public hospitals face great pressure in cost control. It is necessary to strengthen the internal control operation management of public hospitals, establish CRRT clinical operation standards, and improve the quality of medical services in public hospitals.

Citation： SHI Liwei, QIU Yingpeng, XIANG Yang, LIU Kejun, XIAO Yue. Cost estimation and influencing factor analysis of continuous renal replacement therapy. West China Medical Journal, 2022, 37(12): 1818-1823. doi: 10.7507/1002-0179.202205155 Copy

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2.	劉龍巖. 急性腎損傷腎臟替代治療模式選擇研究. 貴州醫藥, 2018, 42(4): 413-416.
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5.	劉書鳳, 余毅. 急性腎損傷血液凈化模式選擇的成本-效益分析. 中國血液凈化, 2018, 17(11): 773-776.
6.	Smedt DD, Elseviers M, Lins R, et al. Economic evaluation of different treatment modalities in acute kidney injury. Nephrol Dial Transplant, 2010, 27(7): 4095-4101.
7.	Mehta RL, McDonald B, Gabbai FB, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int, 2001, 60(3): 1154-1163.
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12.	史黎煒, 劉亭亭, 滕佳利, 等. 超聲引導下真空輔助旋切術診治乳腺腫塊的成本測算及預算影響分析. 醫學與社會, 2021, 34(12): 59-63.
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15.	李果. 武漢市連續性腎替代治療應用現況及成本測算研究. 武漢: 武漢大學, 2018.
16.	王小京, 賈婷. 新醫院財務制度下醫院成本控制策略探究. 經貿實踐, 2018(23): 213.
17.	張勇. 持續性腎臟替代治療的臨床過程安全管理研究. 沈陽: 中國醫科大學, 2020.
18.	劉景院, 李昂. 連續性腎臟替代治療的規范與質量控制: 應重視的問題. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 169-173.
19.	陳麗萍. 質量控制在 ICU 患者 CRRT 血液凈化中的應用價值. 中外醫學研究, 2022, 20(12): 70-74.
20.	王丹, 侯宇澄. 醫療機構績效評價理論及其對中國公立醫院績效評估的啟示. 中國衛生信息管理雜志, 2015, 12(3): 254-259.
21.	胡宏偉, 龔曦, 馬迎花. 地方醫療服務價格改革政策體系預評估: 指標體系與價值討論. 中國醫療保險, 2022(3): 11-15.
22.	董蓬玉, 項鍥, 肖嵩, 等. 我國醫療費用現狀分析. 醫學與社會, 2018, 31(12): 8-11.
23.	宋戈. 公立醫院經濟運行管理能力的多維度構建提升路徑. 中國市場, 2021(12): 107-108.
24.	陶愛林, 蔡蒙蒙. 加強內控建設促進醫院高質量發展. 經濟師, 2021(11): 272-274.

1. Villa G, Neri M, Bellomo R, et al. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications. Crit Care, 2016, 20(1): 283.
2. 劉龍巖. 急性腎損傷腎臟替代治療模式選擇研究. 貴州醫藥, 2018, 42(4): 413-416.
3. Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey. Lancet, 2015, 386(10002): 1465-1471.
4. 鄔步云, 季大璽. 重視國際腎臟病學會急性腎損傷的“Oby25”倡議. 中國血液凈化, 2015, 14(7): 384-387.
5. 劉書鳳, 余毅. 急性腎損傷血液凈化模式選擇的成本-效益分析. 中國血液凈化, 2018, 17(11): 773-776.
6. Smedt DD, Elseviers M, Lins R, et al. Economic evaluation of different treatment modalities in acute kidney injury. Nephrol Dial Transplant, 2010, 27(7): 4095-4101.
7. Mehta RL, McDonald B, Gabbai FB, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int, 2001, 60(3): 1154-1163.
8. 張奇林, 汪畢芳. 技術進步與醫療衛生費用的增長. 社會保障研究, 2010(2): 39-42.
9. 國家衛生健康委員會, 國家中醫藥管理局. 關于印發公立醫院成本核算規范的通知: 國衛財務發〔2021〕4 號. (2021-02-03)[2022-05-01]. http://www.nhc.gov.cn/caiwusi/s7785t/202102/e3fa2383ac944459b304c497359b07b1.shtml.
10. 肖月, 邱英鵬, 史黎煒, 等. 醫用設備評估方法學研究. 中國醫學裝備, 2019, 16(11): 163-172.
11. 周海龍, 江芹, 于麗華, 等. 醫院成本核算方法和體系構建探討. 中國衛生經濟, 2021, 40(5): 72-73.
12. 史黎煒, 劉亭亭, 滕佳利, 等. 超聲引導下真空輔助旋切術診治乳腺腫塊的成本測算及預算影響分析. 醫學與社會, 2021, 34(12): 59-63.
13. Drummond MF, Sculpher MJ, Claxton K, et al. Methods for the econnomic evaluation of health care programmes. 4th ed. Oxford: Oxford University Press, 2015: 57-58.
14. 雷金娟. 魚骨圖分析法在護理不良事件管理中的應用. 中國醫藥指南, 2013(17): 303-304.
15. 李果. 武漢市連續性腎替代治療應用現況及成本測算研究. 武漢: 武漢大學, 2018.
16. 王小京, 賈婷. 新醫院財務制度下醫院成本控制策略探究. 經貿實踐, 2018(23): 213.
17. 張勇. 持續性腎臟替代治療的臨床過程安全管理研究. 沈陽: 中國醫科大學, 2020.
18. 劉景院, 李昂. 連續性腎臟替代治療的規范與質量控制: 應重視的問題. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 169-173.
19. 陳麗萍. 質量控制在 ICU 患者 CRRT 血液凈化中的應用價值. 中外醫學研究, 2022, 20(12): 70-74.
20. 王丹, 侯宇澄. 醫療機構績效評價理論及其對中國公立醫院績效評估的啟示. 中國衛生信息管理雜志, 2015, 12(3): 254-259.
21. 胡宏偉, 龔曦, 馬迎花. 地方醫療服務價格改革政策體系預評估: 指標體系與價值討論. 中國醫療保險, 2022(3): 11-15.
22. 董蓬玉, 項鍥, 肖嵩, 等. 我國醫療費用現狀分析. 醫學與社會, 2018, 31(12): 8-11.
23. 宋戈. 公立醫院經濟運行管理能力的多維度構建提升路徑. 中國市場, 2021(12): 107-108.
24. 陶愛林, 蔡蒙蒙. 加強內控建設促進醫院高質量發展. 經濟師, 2021(11): 272-274.

West China Medical Journal

Cost estimation and influencing factor analysis of continuous renal replacement therapy

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