透析施設の所有権と,血液透析を受けている患者のエポエチン投与
Mae Thamer1, Yi Zhang, James Kaufman
1Medical Technology and Practice Patterns Institute, Bethesda, Md 20814, USA.
JAMA
|April 19, 2007
まとめ
透析施設の所有権は,貧血に対するエポエチン投与に影響します. 営利目的の連鎖は,非営利目的の施設と比較して,より高い用量を投与し,より大きな調整を行います.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 医療サービス 研究 医療サービス
- 薬学経済学 薬学経済学
背景:
- エポエチン治療は,透析関連の貧血に対する主要なメディケア薬費です.
- 所有権を含む透析施設の特徴は,エポエチンの処方パターンと費用に影響を与える可能性があります.
研究 の 目的:
- 透析施設の所有権と処方されたエポエチン投与量との関係を調査する.
- 利益状況,チェーン関連,施設タイプがエポエチン投与にどのように影響するかを分析する.
主な方法:
- 2004年11月から12月に米国腎臓データシステムのデータを分析し,ヘモダイアリスを受けた159,522人の成人末期腎疾患患者を対象とした.
- 平均エポエチン用量を比較し,異なる施設所有者タイプ (営利 vs 非営利,チェーン vs 独立) での用量調整を比較するために回帰モデルを使用しました.
主要な成果:
- 大規模な営利目的の透析連鎖の患者は,非営利目的の施設の患者よりも著しく高いエポエチン用量 (平均3306U/wt以上) を受けた.
- 営利目的の施設では,特に低血球濃度 (<33%) の患者に対して,より積極的な用量調整が示されました.
- 大規模な連鎖施設では,患者ケースミックスが似ても,週間のエポエチン用量 (17,832 Uから24,986 U) の有意な変動が観察されました.
結論:
- 透析施設の所有権と組織構造は,米国におけるエポエチン投与量の変動の重要な要因である.
- 営利目的の連鎖は,より大きな用量調整や,より高い血球濃度を目指すなど,異なる用量戦略を示しています.
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