Comparing the Cost-Utility of Renal Replacement Therapies Delivered to Critically Ill Patients With Acute Kidney Injury in the United States
Author(s)
Rui Martins, MSc1, Ron Wald, M.D2, Jay L. Koyner, M.D3, Kai Harenski, M.D4, Jorge Echeverri, M.D5;
1Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland, 2St. Michael’s Hospital, University of Toronto, Division of Nephrology, Toronto, ON, Canada, 3University of Chicago, Section of Nephrology, Chicago, IL, USA, 4Baxter Deutschland GmbH, Medical Affairs, Unterschleissheim, Germany, 5Baxter Healthcare Corporation, Medical Affairs, Deerfield, IL, USA
1Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland, 2St. Michael’s Hospital, University of Toronto, Division of Nephrology, Toronto, ON, Canada, 3University of Chicago, Section of Nephrology, Chicago, IL, USA, 4Baxter Deutschland GmbH, Medical Affairs, Unterschleissheim, Germany, 5Baxter Healthcare Corporation, Medical Affairs, Deerfield, IL, USA
Presentation Documents
OBJECTIVES: Acute kidney injury (AKI) is common in patients admitted to intensive care units (ICU), with approximately 10-15% requiring acute renal replacement therapy (RRT). Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) are well-established treatments for severe AKI, but controversy remains over which modality is clinically superior and more cost-effective. This study used available data to estimate the cost-utility of CRRT compared with IHD for treating AKI in the ICU using a United States (US) third-party perspective.
METHODS: A decision tree simulated the clinical pathway from hospital admission to 90 days, tracking individuals’ renal replacement therapy (RRT) needs. A semi-Markov model with annual cycles captured the long-term consequences and costs of end-stage kidney disease, dialysis, and kidney transplantation. The effect of RRT on 90-day dialysis dependence was sourced from a propensity score-adjusted analysis of real-world data, representative of the US AKI population. The long-term impact of chronic kidney disease (CKD) and costs were obtained from national databases and standard sources. Preference-elicited utility values were obtained from peer-reviewed publications. The results were subject to half-cycle correction and 3% annual discounting. Uncertainty was explored in deterministic and probabilistic sensitivity analyses.
RESULTS: Base case results suggest that CRRT is cost-effective compared with IHD, leading to 0.230 additional quality-adjusted life years (QALYs) and $5,314 in additional costs ($23,058/QALY). The results were sensitive to the long-term medical costs of CKD progression, which accounted for approximately 50% of the excess costs attributed to the CRRT strategy. The model suggests that clarifying the role of RRT in CKD progression and improving post-AKI care is of vital importance to improving patient outcomes.
CONCLUSIONS: Continuous RRT is likely cost-effective for managing AKI in the ICU compared to IHD. This work expands existing economic evaluations of RRT modalities by incorporating large comparative studies and exploring clinical uncertainty.
METHODS: A decision tree simulated the clinical pathway from hospital admission to 90 days, tracking individuals’ renal replacement therapy (RRT) needs. A semi-Markov model with annual cycles captured the long-term consequences and costs of end-stage kidney disease, dialysis, and kidney transplantation. The effect of RRT on 90-day dialysis dependence was sourced from a propensity score-adjusted analysis of real-world data, representative of the US AKI population. The long-term impact of chronic kidney disease (CKD) and costs were obtained from national databases and standard sources. Preference-elicited utility values were obtained from peer-reviewed publications. The results were subject to half-cycle correction and 3% annual discounting. Uncertainty was explored in deterministic and probabilistic sensitivity analyses.
RESULTS: Base case results suggest that CRRT is cost-effective compared with IHD, leading to 0.230 additional quality-adjusted life years (QALYs) and $5,314 in additional costs ($23,058/QALY). The results were sensitive to the long-term medical costs of CKD progression, which accounted for approximately 50% of the excess costs attributed to the CRRT strategy. The model suggests that clarifying the role of RRT in CKD progression and improving post-AKI care is of vital importance to improving patient outcomes.
CONCLUSIONS: Continuous RRT is likely cost-effective for managing AKI in the ICU compared to IHD. This work expands existing economic evaluations of RRT modalities by incorporating large comparative studies and exploring clinical uncertainty.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE49
Topic
Economic Evaluation
Disease
SDC: Urinary/Kidney Disorders