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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19.	陈丽萍. 质量控制在 ICU 患者 CRRT 血液净化中的应用价值. 中外医学研究, 2022, 20(12): 70-74.
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21.	胡宏伟, 龚曦, 马迎花. 地方医疗服务价格改革政策体系预评估: 指标体系与价值讨论. 中国医疗保险, 2022(3): 11-15.
22.	董蓬玉, 项锲, 肖嵩, 等. 我国医疗费用现状分析. 医学与社会, 2018, 31(12): 8-11.
23.	宋戈. 公立医院经济运行管理能力的多维度构建提升路径. 中国市场, 2021(12): 107-108.
24.	陶爱林, 蔡蒙蒙. 加强内控建设促进医院高质量发展. 经济师, 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. 刘龙岩. 急性肾损伤肾脏替代治疗模式选择研究. 贵州医药, 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. 邬步云, 季大玺. 重视国际肾脏病学会急性肾损伤的“Oby25”倡议. 中国血液净化, 2015, 14(7): 384-387.
5. 刘书凤, 余毅. 急性肾损伤血液净化模式选择的成本-效益分析. 中国血液净化, 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. 张奇林, 汪毕芳. 技术进步与医疗卫生费用的增长. 社会保障研究, 2010(2): 39-42.
9. 国家卫生健康委员会, 国家中医药管理局. 关于印发公立医院成本核算规范的通知: 国卫财务发〔2021〕4 号. (2021-02-03)[2022-05-01]. http://www.nhc.gov.cn/caiwusi/s7785t/202102/e3fa2383ac944459b304c497359b07b1.shtml.
10. 肖月, 邱英鹏, 史黎炜, 等. 医用设备评估方法学研究. 中国医学装备, 2019, 16(11): 163-172.
11. 周海龙, 江芹, 于丽华, 等. 医院成本核算方法和体系构建探讨. 中国卫生经济, 2021, 40(5): 72-73.
12. 史黎炜, 刘亭亭, 滕佳利, 等. 超声引导下真空辅助旋切术诊治乳腺肿块的成本测算及预算影响分析. 医学与社会, 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. 鱼骨图分析法在护理不良事件管理中的应用. 中国医药指南, 2013(17): 303-304.
15. 李果. 武汉市连续性肾替代治疗应用现况及成本测算研究. 武汉: 武汉大学, 2018.
16. 王小京, 贾婷. 新医院财务制度下医院成本控制策略探究. 经贸实践, 2018(23): 213.
17. 张勇. 持续性肾脏替代治疗的临床过程安全管理研究. 沈阳: 中国医科大学, 2020.
18. 刘景院, 李昂. 连续性肾脏替代治疗的规范与质量控制: 应重视的问题. 中华重症医学电子杂志(网络版), 2017, 3(3): 169-173.
19. 陈丽萍. 质量控制在 ICU 患者 CRRT 血液净化中的应用价值. 中外医学研究, 2022, 20(12): 70-74.
20. 王丹, 侯宇澄. 医疗机构绩效评价理论及其对中国公立医院绩效评估的启示. 中国卫生信息管理杂志, 2015, 12(3): 254-259.
21. 胡宏伟, 龚曦, 马迎花. 地方医疗服务价格改革政策体系预评估: 指标体系与价值讨论. 中国医疗保险, 2022(3): 11-15.
22. 董蓬玉, 项锲, 肖嵩, 等. 我国医疗费用现状分析. 医学与社会, 2018, 31(12): 8-11.
23. 宋戈. 公立医院经济运行管理能力的多维度构建提升路径. 中国市场, 2021(12): 107-108.
24. 陶爱林, 蔡蒙蒙. 加强内控建设促进医院高质量发展. 经济师, 2021(11): 272-274.

West China Medical Journal

Cost estimation and influencing factor analysis of continuous renal replacement therapy

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