Title
The Cost-Effectiveness of Continuous Versus Intermittent Renal Replacement Therapies in Acute Kidney Injury: Perspective of the Social Services for the Elderly in Argentina
Date Issued
01 December 2019
Access level
open access
Resource Type
journal article
Author(s)
Garay O.U.
Palacios A.
Pichon-Riviere A.
Augustovski F.
Martí S.G.
López E.T.
Rosa-Díez G.
Bardach A.
Publisher(s)
Elsevier Inc.
Abstract
Background: Acute kidney injury (AKI) is a public health problem that affects millions of hospitalized patients worldwide. In Argentina, evidence suggests that its incidence has risen in recent years. When severe, AKI may require a renal replacement therapy (RRT) where continuous RRT (CRRT) and intermittent RRT (IRRT) are plausible options for patients in the intensive care unit. Objective: To evaluate the cost utility of CRRT versus IRRT for the National Institute of Social Services for Retirees and Pensioners, the largest social security health insurance for elders in Argentina. Methods: This was a model-based cost-utility analysis. Long-term costs and health outcomes were estimated for a hypothetical cohort with a Markov model. Parameters used were obtained from published literature and validated with local experts. Local costs were estimated and expressed in $AR of 2016. Several sensitivity analyses were run to analyze the impact of uncertainty on results. Results: Continuous RRT dominated IRRT by cumulating over the model more quality-adjusted life years and less costs. Total discounted quality-adjusted life years for both cohorts were 1049 and 1034, respectively, and total costs were $95 362 and $103 871. Cost-effectiveness (CE) results reflect these differences in favor of CRRT with a deterministic cost-saving incremental CE ratio and a probability of CRRT being CE of 65.4%, considering a CE threshold of 1 gross domestic product per capita. Conclusions: Continuous RRT for patients with AKI eligible for CRRT or IRRT would probably be a cost-effective intervention for the National Institute of Social Services for Retirees and Pensioners’ view. Nevertheless, there is considerable uncertainty around results, mainly due to the lack of adequate controlled studies and local data on the prognosis of these patients in Argentina.
Start page
142
End page
148
Volume
20
Language
English
OCDE Knowledge area
Urología, Nefrología
Subjects
Scopus EID
2-s2.0-85070705877
PubMed ID
Source
Value in Health Regional Issues
ISSN of the container
22121099
Sponsor(s)
We thank Horacio Trevisani, Ricardo Heguilen, Fernando Lombi, Cecilia Loudet, Ricardo Martínez, and Guillermo Rosa-Diez for their participation on the Delphi panel, and Darío Balán for his valuable comments and work on this manuscript. This study was funded with an independent grant from Baxter Inc.
This study was funded with an independent grant from Baxter Inc .
Sources of information:
Directorio de Producción Científica
Scopus