Economic Analysis of Renal Replacement Therapy Modality in Acute Kidney Injury Patients With Fluid Overload.
Crit Care Explor
; 5(6): e0921, 2023 Jun.
Article
em En
| MEDLINE
| ID: mdl-37637357
ABSTRACT
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 ORSUBJECTS:
AKI patients with FO.INTERVENTIONS:
IHD or CRRT. MEASUREMENTS AND MAINRESULTS:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Idioma:
En
Revista:
Crit Care Explor
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Bélgica