A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.
BACKGROUND: Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. METHODS: . We developed a simulation model of individuals progressing towards ESRD and requiring dialysis...
| Publicado en: | Medical Decision Making Vol. 26; no. 5; pp. 535 - 550 |
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| Autores principales: | , , |
| Formato: | research Journal Article |
| Publicado: |
Sage Publications Inc.
Sep/Oct2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105945413&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105945413 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0272989X DKI jtl: Medical Decision Making issn: 0272989X maglogo: Y pubinfo: dt: Sep/Oct2006 vid: 26 iid: 5 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 105945413 105945413 2009293026 10.1177/0272989x06290488 NLM16997929 105945413 ppf: 535 ppct: 15 formats: tig: atl: A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies. aug: au: Lee CP Chertow GM Zenios SA sug: subj: Computer Simulation Hemodialysis Methods Kidney Failure, Chronic Therapy Models, Statistical Aged Aged, 80 and Over Costs and Cost Analysis Demography Female Hemodialysis Economics Kidney Failure, Chronic Economics Kidney Transplantation Economics Kidney Transplantation Male Middle Age Survival Analysis Human Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: BACKGROUND: Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. METHODS: . We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. RESULTS: . Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. CONCLUSION: . The model produces reliable results and is robust. It enables the cost-effetiveness analysis of dialysis strategies. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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