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Economic evaluation of different treatment modalities in acute kidney injury.
Nephrol Dial Transplant. 2012 Nov; 27(11):4095-101.ND

Abstract

BACKGROUND

Major controversy exists regarding the preferred treatment option for acute kidney injury (AKI). The purpose of this study was to assess the incremental cost-effectiveness of continuous renal replacement therapy (CRRT) versus intermittent renal replacement therapy (IRRT) and conservative (CONS) AKI treatment in Belgium.

METHODS

An area-under-the-curve model based on survival analysis was used to estimate costs and health outcomes using a 2-year time horizon. Input data were derived from the multi-centre Stuivenberg Hospital Acute Renal Failure 4 study.

RESULTS

Analyses indicated that in-hospital mortality, hospitalization costs and hospital length of stay differed significantly between treatment modes. Follow-up mortality rates and follow-up cost per day showed no significant difference between the treatment modes. Utility values, which improved gradually after admission to the hospital, revealed no significant differences between the three treatment strategies. CONS treatment was associated with a 2-year cost of 33,802€ and 0.54 quality-adjusted life years (QALYs). The CRRT was the most expensive therapy with a cost of 51,365€ leading to 0.57 QALYs. The cost and QALYs associated with IRRT were 43,445€ and 0.50, respectively. One-way sensitivity analyses indicated the 'in-hospital mortality' as the variable with the greatest influence on the results. Probabilistic sensitivity analysis resulted in a significant difference in treatment costs but no significant difference in QALY gain.

CONCLUSIONS

This study has indicated that the most expensive treatment (CRRT) associated with an incremental cost of approximately €7920 generates only a minor non-significant increase in QALYs of 0.07 compared with IRRT. Additionally, the results revealed that the RRTs did not result in a significant increase in QALYs despite their higher cost compared with the CONS treatment. From a health economic perspective, the latter seems to be the preferred treatment strategy.

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Authors+Show Affiliations

De Smedt DM
Department of Public health, Ghent University, Ghent, Belgium. delphine.desmedt@ugent.be
Elseviers MM
No affiliation info available
Lins RL
No affiliation info available
Annemans L
No affiliation info available

MeSH

Acute Kidney InjuryArea Under CurveBelgiumCost-Benefit AnalysisHospital CostsHospital MortalityHumansLength of StayModels, EconomicRenal Replacement TherapySurvival AnalysisTreatment Outcome

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23144072

Citation

De Smedt, Delphine M., et al. "Economic Evaluation of Different Treatment Modalities in Acute Kidney Injury." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 27, no. 11, 2012, pp. 4095-101.
De Smedt DM, Elseviers MM, Lins RL, et al. Economic evaluation of different treatment modalities in acute kidney injury. Nephrol Dial Transplant. 2012;27(11):4095-101.
De Smedt, D. M., Elseviers, M. M., Lins, R. L., & Annemans, L. (2012). Economic evaluation of different treatment modalities in acute kidney injury. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 27(11), 4095-101. https://doi.org/10.1093/ndt/gfs410
De Smedt DM, et al. Economic Evaluation of Different Treatment Modalities in Acute Kidney Injury. Nephrol Dial Transplant. 2012;27(11):4095-101. PubMed PMID: 23144072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic evaluation of different treatment modalities in acute kidney injury. AU - De Smedt,Delphine M, AU - Elseviers,Monique M, AU - Lins,Robert L, AU - Annemans,Lieven, PY - 2012/11/13/entrez PY - 2012/11/13/pubmed PY - 2013/6/29/medline SP - 4095 EP - 101 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 27 IS - 11 N2 - BACKGROUND: Major controversy exists regarding the preferred treatment option for acute kidney injury (AKI). The purpose of this study was to assess the incremental cost-effectiveness of continuous renal replacement therapy (CRRT) versus intermittent renal replacement therapy (IRRT) and conservative (CONS) AKI treatment in Belgium. METHODS: An area-under-the-curve model based on survival analysis was used to estimate costs and health outcomes using a 2-year time horizon. Input data were derived from the multi-centre Stuivenberg Hospital Acute Renal Failure 4 study. RESULTS: Analyses indicated that in-hospital mortality, hospitalization costs and hospital length of stay differed significantly between treatment modes. Follow-up mortality rates and follow-up cost per day showed no significant difference between the treatment modes. Utility values, which improved gradually after admission to the hospital, revealed no significant differences between the three treatment strategies. CONS treatment was associated with a 2-year cost of 33,802€ and 0.54 quality-adjusted life years (QALYs). The CRRT was the most expensive therapy with a cost of 51,365€ leading to 0.57 QALYs. The cost and QALYs associated with IRRT were 43,445€ and 0.50, respectively. One-way sensitivity analyses indicated the 'in-hospital mortality' as the variable with the greatest influence on the results. Probabilistic sensitivity analysis resulted in a significant difference in treatment costs but no significant difference in QALY gain. CONCLUSIONS: This study has indicated that the most expensive treatment (CRRT) associated with an incremental cost of approximately €7920 generates only a minor non-significant increase in QALYs of 0.07 compared with IRRT. Additionally, the results revealed that the RRTs did not result in a significant increase in QALYs despite their higher cost compared with the CONS treatment. From a health economic perspective, the latter seems to be the preferred treatment strategy. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/23144072/Economic_evaluation_of_different_treatment_modalities_in_acute_kidney_injury_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfs410 DB - PRIME DP - Unbound Medicine ER -