Economic Analysis of Renal Replacement Therapy Modality in Acute Kidney Injury Patients With Fluid Overload
OBJECTIVES: Acute kidney injury (AKI) and fluid overload (FO) are among the top reasons to initiate intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Prior research suggests CRRT provides more precise volume control, but whether CRRT is cost-effective remains unclear. W...
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| Published in | Critical care explorations Vol. 5; no. 6; p. e0921 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
05.06.2023
Wolters Kluwer |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2639-8028 2639-8028 |
| DOI | 10.1097/CCE.0000000000000921 |
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| Summary: | OBJECTIVES:
Acute kidney injury (AKI) and fluid overload (FO) are among the top reasons to initiate intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Prior research suggests CRRT provides more precise volume control, but whether CRRT is cost-effective remains unclear. We assessed the cost-effectiveness of CRRT for volume control compared with IHD from a U.S. healthcare payer perspective.
DESIGN:
Decision analytical model comparing health outcomes and healthcare costs of CRRT versus IHD initiation for AKI patients with FO. The model had an inpatient phase (over 90-d) followed by post-discharge phase (over lifetime). The 90-day phase had three health states: FO, fluid control, and death. After 90 days, surviving patients entered the lifetime phase with four health states: dialysis independent (DI), dialysis dependent (DD), renal transplantation, and death. Model parameters were informed by current literature. Sensitivity analyses were performed to evaluate results robustness to parametric uncertainty.
SETTING:
ICU.
PATIENTS OR SUBJECTS:
AKI patients with FO.
INTERVENTIONS:
IHD or CRRT.
MEASUREMENTS AND MAIN RESULTS:
The 90-day horizon revealed better outcomes for patients initiated on CRRT (survival: CRRT 59.2% vs IHD 57.5% and DD rate among survivors: CRRT 5.5% vs IHD 6.9%). Healthcare cost was 2.7% (+$2,836) higher for CRRT. Over lifetime, initial CRRT was associated with +0.313 life years (LYs) and +0.187 quality-adjusted life years (QALYs) compared with initial IHD. Even though important savings were observed for initial CRRT with a lower rate of DD among survivors (-$13,437), it did not fully offset the incremental cost of CRRT (+$1,956) and DI survival (+$12,830). The incremental cost-per-QALY gained with CRRT over IRRT was +$10,429/QALY. Results were robust to sensitivity analyses.
CONCLUSIONS:
Our analysis provides an economic rationale for CRRT as the initial modality of choice in AKI patients with FO who require renal replacement therapy. Our finding needs to be confirmed in future research. |
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| Bibliography: | The results presented in this article have not been published previously in whole or in part. The present economic analysis was funded by Baxter Healthcare Corporation. This publication was subject to review by internal employees from Baxter Healthcare Corporation prior to submission for protection of Confidential Information. However, the authors retain full responsibility for the content of this publication. Drs. Ethgen and Murugan are authors of the publication and have received consulting fees from Baxter Healthcare Corporation for developing the present economic model. Dr. Ostermann is an author of the publication and received fees for developing the present model which were used to support research activities in the institution. Dr. Echeverri, Dr. Blackowicz, and Dr. Harenski are full-time employees of Baxter International with ownership interest. The present economic model has not been registered on clinical.trials.gov. Dr. Ethgen was involved in conceptualization, methodology, formal analysis, and writing-original draft. Dr. Murugan was involved in conceptualization, methodology validation, and writing-review & editing. Dr. Echeverri was involved in project administration, resources, and writing-review & editing. Blackowicz was involved in project administration, resources, and writing-review & editing. Dr. Harenski was involved in project administration, resources, and writing-review & editing. Dr. Ostermann was involved in conceptualization, methodology, formal analysis, validation, and writing-review & editing. All authors critically reviewed and approved the final version for submission. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccejournal). For information regarding this article, E-mail: o.ethgen@uliege.be ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 2639-8028 2639-8028 |
| DOI: | 10.1097/CCE.0000000000000921 |