透析療法と腎移植 : 医療経済と患者の生活の質における比較

Abstract

We studied the medical costs of hemodialysis, CAPD and renal transplantation in our patients with chronic renal failure. The cost per patient averaged 660, 000 yen for hemodialysis (760, 000 yen for CAPD) in the first month when dialysis was started and 460, 000 yen for routine maintenance hemodialysis (240, 000 yen for CAPD). There was a difference in cost between recipients treated with conventional immunosuppressants (conventional group) and those receiving cyclosporine (Cs-group). That is, the estimated average cost for the conventional group was 3, 800, 000 in the first month after kidney grafting and at 60, 000 yen in the subsequent months when the patient is cared for at the outpatient clinic; that of Cs-group was at 2, 710, 000 yen and 170, 000 yen. This difference is due to the high cost of cyclosporine. The cumulative cost of maintenance hemodialysis is on a constant linear increase. Recently, clinical results of renal transplantation have improved markedly. Furthermore, our analysis of questionnaires to patients shows that renal transplantation is far superior to hemodialysis on the aspect of the quality of life. Thus, renal transplantation should be promoted further, and then the combined treatment of a low dose of cyclosporine and other immunosuppressants might be recommended to reduce the cost of cyclosporine.