Kalıcı tünelli veya geçici hemodiyaliz kateteri ile rutin hemodiyaliz programında olan hasta grubunda kateter tipine göre Maliyet-Etkinlik araştırması

Öz

ÖZET Amaç: Bu çalışmamızda hemodiyaliz kateteri takılarak rutin hemodiyaliz programına dahil edilen hastaların kateterlerinin aktif kullanılabildiği günleri tespit edip, kateter maliyetlerinin de belirlenerek kateter çeşidine göre maliyet/etkinlik araştırması yapmayı amaçladık. Gereç ve Yöntem: 2013-2020 tarihleri arasında geçici hemodiyaliz kateteri takılan hastalar (Grup 1) ve tünelli hemodiyaliz kateteri takılanlar (Grup 2) hastane arşivi taranarak tespit edildi. Bir sonraki kateter takılma tarihlerine göre kateterlerin aktif kullanıldığı gün sayısı hesaplandı. Ardından hastane muhasebe servisinden güncel sağlık uygulamaları tebliğine göre devletin kalıcı ve geçici kateterler için ödediği ücret tespit edildi. SPSS 22 programı kullanılarak gün başına düşen kateter maliyeti belirlendi. Bulgular: Demografik özelliklere göre yapılan incelemede gruplar arasında cinsiyet açısından anlamlı farklılık tespit edilmedi (p=0.129). Hastalardaki yaş ortalamasına bakıldığında gruplar arasında farklılık bulunmadı (p=0.085). Diyabet, hipertansiyon ve koroner arter hastalığı açısından yapılan değerlendirmede de gruplar arasında istatistiksel farklılık bulunmadı (p=0,219, p=0,129, p=0,822). Grup 2 de açık kalma süreleri anlamlı olarak yüksek idi ( p<0.001). Kateterlerin yerleştirilme bölgesi olarak Grup 1 için en çok femoral (p<0.001), Grup 2 için ise juguler (p<0.001) bölgenin tercih edildiği görülmüştür. Birim gün başına düşen kateter maliyeti hesaplandığında ise Grup 1 in anlamlı oranda daha az maliyetli olduğu anlaşılmıştır (p=0.031). Sonuç: Geçici hemodiyaliz kateterleri kalıcı tünelli hemodiyaliz kataterlerine göre maliyet etkin ürünlerdir. Anahtar Kelimeler:Hemodializ katateri maliyet/etkinlik,Geçici hemodializ katateri, Kalıcı tünelli hemodializ katateri,Femoral ven, Juguler ven

Anahtar Kelimeler

• Hemodializ katateri maliyet/etkinlik
• Geçici hemodializ katateri
• Kalıcı tünelli hemodializ katateri
• Femoral ven
• Juguler ven

Cost-Effectiveness research according to the type of catheter in the group of patients on routine hemodialysis program with permanent tunneled or temporary hemodialysis catheters

Öz

Abstract Background: In this study, our aim was to conduct a cost/effectiveness research by determining the cost , in the patients who are in the routine hemodialysis program with a hemodialysis catheter, according to type of the catheter and the number of the days in which the catheters can be used actively. Methods: Between 2013 and 2020,patients with temporary hemodialysis catheters (Group 1 , n:81) and patients tunneled hemodialysis catheters (Group 2, n:205) were identified by scanning the hospital archive. The number of days in which the catheters were actively used was calculated according to the next catheter insertion or replacement date. Then, the permanent and temporary catheter fees paid by the governmentdetermined, according to the current Health Practices Communique (SUT) pricing that learnt from the hospital accounting department. Catheter cost per day was determined using the SPSS 22 program. Results: In the analysis made according to demographic characteristics, no significant difference was found between the groups in terms of gender (p=0.129). When the mean age of the patients was examined, no difference was found between the groups (p=0.085). No statistical difference was found between the groups in comorbid conditions: diabetes, hypertension, and coronary artery disease (p=0.219, p=0.129, p=0.822). The patency period was significantly higher in group 2 (p<0.001). It was observed that the femoral (p<0.001) region was preferred most for Group 1 patients and the jugular region (p<0.001) for Group 2 patients as the placement site of the catheters. When the catheter cost per unit day was calculated, it was understood that Group 1 was significantly less costly (p=0.031). Conclusion: Temporary hemodialysis catheters are cost/effective products compared to permanent tunneled catheters. Keywords: Hemodialysis catheter cost/effectiveness,Temporary hemodialysis catheter, Permanent tunneled hemodialysis catheter,Femoral vein, Jugular vein

Anahtar Kelimeler

• Keywords:Hemodialysis catheter cost/effectiveness
• Temporary hemodialysis catheter
• Permanent tunneled hemodialysis catheter
• Femoral vein
• Jugular vein

Kaynakça

1. References: 1- K.T. Woo, H.L. Choong, K.S. Wong, H.B. Tan, C.M. Chan The contribution of chronic kidney disease to the global burden of major noncommunicable diseases Kidney Int, 81 (2012), pp. 1044-1045.doi:10.1038/ki.2012.39
2. 2- H.C. Rayner, R.L. Pisoni The increasing use of hemodialysis catheters: evidence from the DOPPS on its significance and ways to reverse it Semin Dial, 23 (2010), pp. 6-10.doi:10,1111/j.1525-139X.2009.00675.x.
3. 3- Xiao-Chun Ling, Hsi-Peng Lu, El-Wui Loh,(et al), A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters,Journal of Vascular Surgery Volume 69; 4 (2019) pp 1282-1292.doi:10.1016./j.jvs.2018.09.029.
4. 4- M.G. Knuttinen, S. Bobra, J. Hardman, R.C. Gaba, J.T. Bui, C.A. Owens.A review of evolving dialysis catheter technologies Semin Intervent Radiol, 26 (2009), pp. 106-114.doi:10.1055./s-0029-1222453/s.
5. 5-Sheng, K. X., Zhang, P., Li, J. W., (et al)(2020). Comparative efficacy and safety of lock solutions for the prevention of catheter-related complications including infectious and bleeding events in adult haemodialysis patients: a systematic review and network meta-analysis. Clinical Microbiology and Infection, 26(5), 545-552.doi:10.1016/j.cmi.2019.12.003.Epub 2019 Dec 16.
6. 6-Jean Ethier, David C. Mendelssohn, (et al)Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study, Nephrology Dialysis Transplantation, Volume 23, Issue 10, October 2008, Pages 3219–3226, https://doi.org/10.1093/ndt/gfn261
7. 7-Kukavica N, Resic H, Sahovic V. Comparison of complications and dialysis adequacy between temporary and permanent tunnelled catheter for haemodialysis. Bosn J Basic Med Sci. 2009;9(4):265-270. doi:10.17305/bjbms.2009.2776
8. 8-Ogawa, T., Sasaki, Y., Kanayama, Y., Yasuda, K., Okada, Y., Kogure, Y., ... & Hasegawa, H. (2017). Evaluation of the functions of the temporary catheter with various tip types. Hemodialysis International, 21, S10-S15.doi:10.1111/hdi.12596 9-Shahar, S., Mustafar, R., Kamaruzaman, L., Periyasamy, P., Pau, K. B., & Ramli, R. (2021). Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes. International Journal of Nephrology, 2021.doi:10.1155/2021/5562690

9. 10-Erdinçler, D. S.,& Avcı, S. (2017). Kardiyovasküler hastalığı olan yaşlıda beslenme. Turk Kardiyol Dern Ars, 45(5), 113-116.doi:10.5543/tkda.2017.70430
10. 11-Pepper R.J, Gale D.P, Wajed J, et al. Inadvertent postdialysis anticoagulation due to heparin line locks. Hemodialysis International. 2007;11:430.doi:10.1111/j.1542-4758.2007.00213.x
11. 12-Lee, T., Qian, J., Thamer, M., & Allon, M. (2019). Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients. American journal of nephrology, 49(1), 11-19.doi:10.1159/000495261
12. 13-Braunwald, E. (2019). Diabetes, heart failure, and renal dysfunction: the vicious circles. Progress in Cardiovascular Diseases, 62(4), 298-302.do:10.1016/j.pcad.2019.07.003
13. 14-Alpers, C. E.,& Hudkins, K. L. (2018). Pathology identifies glomerular treatment targets in diabetic nephropathy. Kidney research and clinical practice, 37(2), 106.doi:10.23876/j.krcp.2018.37.2.106
14. 15-Sarnak, M. J., Amann, K., Bangalore, S.(et al) (2019). Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. Journal of the American College of Cardiology, 74(14), 1823-1838.doi:10.1016/j.jacc.2019.08.1017
15. 16- Nassar GM, Nguyen B, Rhee E, Achkar K. Endovascular treatment of the "failing to mature" arteriovenous fistula. Clin J Am Soc Nephrol. 2006 Mar;1(2):275-80. doi: 10.2215/CJN.00360705. Epub 2006 Jan 4. PMID: 17699217.
16. 17- Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol. 2004 Feb;15(2):477-86. doi: 10.1097/01.asn.0000109668.05157.05. PMID: 14747396.
17. 18- Hamdan, Z., As' Ad, N., Sawalmeh, O., Shraim, M., & Kukhon, F. (2019). Vascular access types in hemodialysis patients in palestine and factors affecting their distribution: A cross-sectional study.PMID: 30804278
18. 19- Sepas, H. N., Negahi, A., Mousavie, S. H., Vosough, F., & Farazmand, B. (2019). Patency and outcomes of tunneled hemodialysis catheter via femoral versus jugular vein access. Journal of advanced pharmaceutical technology & research, 10(2), 81.doi:10.4103/japtr.JAPTR 38318
19. 20-Tomar Kavraz Ö, Ulusoy Ş, Pulathan Z, Kaynar K. [The determination of duration of survival of permanent vascular access established for hemodialysis in patients with chronic kidney failure and an investigation of the factors affecting those durations]. Int J Basic Clin Med 2016;4(3):144-54.doi:10.53367nurses.2017-57483
20. 21- ÇETİN, Ş., ÇİĞDEM, Z., & ÖZSOY, H. (2018). Hemodiyaliz Hastalarında Vasküler Erişim Yolları ve Hemşirelik Bakımı. Türkiye Klinikleri Hemşirelik Bilimleri Dergisi, 10(2), 144-152.DOI: 10.5336/nurses.2017-57483