RESUMEN
BACKGROUND: Despite the discrepancy in results from Spanish studies on the costs of dialysis, it is assumed that peritoneal dialysis (PD) is more efficient than haemodialysis (HD). OBJECTIVES: To analyse the costs and added value of HD and PD outsourcing agreements in Galicia, the medical transport for HD and the relationship between the cost of the agreement and the cost of consumables used in continuous ambulatory peritoneal dialysis (CAPD) with bicarbonate. METHODS: The cost of the outsourcing agreements and the staff was obtained from official publications. The cost of PD and medical transport were calculated using health service data for one month and extrapolating it to one year. The cost of CAPD consumables was provided by the suppliers. The added value was calculated from the investments generated for each agreement treating 40 patients. RESULTS: Expressed as patient/year, the mean costs for treatment were 21595 and 25664 in HD and PD, respectively. Medical transport varied between 3323 and 6338, while those of the CAPD agreement and consumables were 19268 and 12057, respectively. The added value was greater with the HD agreement, especially considering the jobs created. CONCLUSIONS: One cannot generalise that the cost of PD, which is significantly influenced by prescriptions, is lower than that of HD. It would be appropriate to review the additional cost to consumables in the CAPD agreement. The added value generated by dialysis agreements should be considered in future studies and in health planning. More controlled studies are needed to better understand this issue.
Asunto(s)
Servicios Externos/economía , Diálisis Peritoneal/economía , Diálisis Renal/economía , Bicarbonatos/economía , Análisis Costo-Beneficio , Costos y Análisis de Costo , Soluciones para Diálisis/economía , Equipos Desechables/economía , Financiación Gubernamental/estadística & datos numéricos , Personal de Salud/economía , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/terapia , Programas Nacionales de Salud/economía , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal Ambulatoria Continua/economía , Mecanismo de Reembolso , Diálisis Renal/instrumentación , Seguridad Social/economía , España , Transporte de Pacientes/economíaRESUMEN
PURPOSE: To evaluate the protective effect on corneal endothelial cells of a low-cost and an expensive combination of a dispersive viscoelastic material and an irrigating solution during phacoemulsification. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized examiner- and patient-masked study comprised 90 eyes of 45 consecutive patients with age-related cataract in both eyes. For each patient, the first eye was randomly assigned to receive hydroxypropyl methylcellulose 2% (Ocucoat) and Ringer's solution (low-cost combination) or sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) and an enriched balanced salt solution (BSS Plus) (expensive combination) during phacoemulsification. The contralateral eye received the other treatment. Endothelial cell function was evaluated by measuring corneal thickness (CT) using partial coherence interferometry, morphology assessment, and endothelial cell counts. RESULTS: The acute postoperative increase in CT was +9.8 microm in the low-cost group and +10.9 microm in the expensive group; the difference between groups was not significant. After 1 month, the CT still differed significantly from baseline in the low-cost group. Three months after surgery, the CT had returned to baseline values in both groups. There was no significant between-group difference in endothelial cell counts or morphology. CONCLUSIONS: During phacoemulsification in a nonselected patient population, there was no difference in acute postoperative corneal edema and endothelial cell morphology after 3 months between a Viscoat and BSS Plus combination and an Ocucoat and Ringer's solution combination. Eyes receiving the expensive combination had marginally faster recovery of corneal swelling by 3 months. However, the cost of Viscoat and 500 mL BSS Plus is 5 times that of Ocucoat and Ringer's solution.
Asunto(s)
Bicarbonatos/uso terapéutico , Condroitín/uso terapéutico , Edema Corneal/prevención & control , Endotelio Corneal/efectos de los fármacos , Glutatión/uso terapéutico , Ácido Hialurónico/uso terapéutico , Soluciones Isotónicas/uso terapéutico , Metilcelulosa/análogos & derivados , Metilcelulosa/uso terapéutico , Facoemulsificación/efectos adversos , Anciano , Anciano de 80 o más Años , Bicarbonatos/economía , Recuento de Células , Condroitín/economía , Sulfatos de Condroitina , Edema Corneal/economía , Edema Corneal/etiología , Citoprotección/efectos de los fármacos , Método Doble Ciego , Combinación de Medicamentos , Costos de los Medicamentos , Quimioterapia Combinada , Endotelio Corneal/patología , Glutatión/economía , Humanos , Ácido Hialurónico/economía , Derivados de la Hipromelosa , Soluciones Isotónicas/economía , Metilcelulosa/economía , Persona de Mediana Edad , Soluciones Oftálmicas/economía , Soluciones Oftálmicas/uso terapéutico , Facoemulsificación/economía , Estudios Prospectivos , Solución de RingerAsunto(s)
Bicarbonatos/administración & dosificación , Extracción de Catarata , Glutatión/administración & dosificación , Soluciones Isotónicas/administración & dosificación , Irrigación Terapéutica , Bicarbonatos/economía , Glutatión/economía , Humanos , Soluciones Isotónicas/economía , Lactato de Ringer , Irrigación Terapéutica/economíaRESUMEN
BACKGROUND: Two intraocular irrigating solutions which differ principally by the presence of oxidized glutathione were compared in this randomized, masked, prospective study to discern differences in preservation of endothelial cell size. METHODS: Sixty-four patients undergoing extracapsular cataract extractions were randomized between two irrigating solution groups, Balanced Salt Solution (BSS) Plus (n = 30) and dextrose bicarbonate lactated Ringer's solution (n = 34). Preoperative and postoperative endothelial specular photomicrographs were analyzed for cell size and hexagonality, and the two groups were compared using repeated measures analysis of variance. RESULTS: Fifty-eight subjects (91%) completed the 2-month study. Change in cell size for the BSS Plus group (n = 28) (mean +/- standard error, 29.4 +/- 12.3 microns2) was not significantly different from the dextrose bicarbonate lactated Ringer's solution group (n = 30) (27.5 +/- 12.9 microns2) (P = 0.92). Groups did not differ significantly in percent hexagonality (P = 0.57) or in the variability of cell size (P = 0.61). CONCLUSION: The presence of glutathione in BSS Plus and other minor electrolyte differences between the solutions is not more advantageous with regard to endothelial cell size than dextrose bicarbonate lactated Ringer's solution for standard extracapsular cataract surgery. Cost per 500-microliters bottle of BSS plus is $62 compared with $9.80 for dextrose bicarbonate lactated Ringer's solution.