Medium vs. Low Citrate Concentration in Continuous Kidney Replacement Therapy: Positive Budget Impact Through Total Cost of Ownership Assessment
Author(s)
Marta Medaglia, BSc, MSc1, Suzanne Carroll, BSc, MSc2, Loren Venables, BSc, MSc2, Ellen Busink, BSc, MSc3, Dana Kendzia, BSc, MSc3.
1Fresenius Medical Care, Palazzo Pignano, Italy, 2Fresenius Medical Care (UK) Ltd, Nottinghamshire, United Kingdom, 3Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
1Fresenius Medical Care, Palazzo Pignano, Italy, 2Fresenius Medical Care (UK) Ltd, Nottinghamshire, United Kingdom, 3Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
OBJECTIVES: Use of regional citrate anticoagulation (RCA) in patients with acute kidney injury undergoing continuous kidney replacement therapy is widely accepted and recommended by international guidelines. Various treatment protocols using different citrate concentrations are available, but their clinical efficiency and associated costs can vary. This study compares the total cost of ownership (TCO) between protocols using medium versus low citrate concentrations, assuming equal health outcomes.
METHODS: A budget impact analysis was conducted on a hypothetical group of 100 patients over 300 treatment days, assuming each patient received 72 hours of therapy, from a hospital perspective in the United Kingdom. The analysis covered a one-year period. The low citrate concentration protocol was applied with a pre-post continuous veno-venous hemodiafiltration (CVVHDF) modality, while the medium concentration one used continuous veno-venous hemodialysis (CVVHD). Costs were based on UK framework pricing. Four scenarios were analyzed, using high and low-price bands, either assuming equal unit costs (Scenarios 1-2) or adjusting for citrate concentrations (Scenarios 3-4). Both protocols assumed a circuit lifespan of 72 hours.
RESULTS: The medium citrate concentration CVVHD protocol shows annual cost savings of over £8,700 (Scenario 4: £56,025 vs £64,756; Scenario 3: £80,353 vs £90,349) to £22,256 (Scenario 2: £56,025 vs £74,364; Scenario 1: £79,843 vs £102,099), corresponding to a 11%-25% reduction. Savings are driven by lower fluid volume requirements, which decrease the number of bags and frequency of changes.
CONCLUSIONS: Selecting the appropriate citrate concentration in RCA and treatment modality can importantly affect hospital costs and operational efficiency. CVVHD protocols with medium citrate concentration can decrease hospital costs and nursing staff workload. Additional savings may result from less filter changes due to lower fluid volumes and different calcium infusion set-ups. TCO assessments can better evaluate treatment efficiencies, allowing more comprehensive, value-based procurement decisions beyond unit cost comparisons.
METHODS: A budget impact analysis was conducted on a hypothetical group of 100 patients over 300 treatment days, assuming each patient received 72 hours of therapy, from a hospital perspective in the United Kingdom. The analysis covered a one-year period. The low citrate concentration protocol was applied with a pre-post continuous veno-venous hemodiafiltration (CVVHDF) modality, while the medium concentration one used continuous veno-venous hemodialysis (CVVHD). Costs were based on UK framework pricing. Four scenarios were analyzed, using high and low-price bands, either assuming equal unit costs (Scenarios 1-2) or adjusting for citrate concentrations (Scenarios 3-4). Both protocols assumed a circuit lifespan of 72 hours.
RESULTS: The medium citrate concentration CVVHD protocol shows annual cost savings of over £8,700 (Scenario 4: £56,025 vs £64,756; Scenario 3: £80,353 vs £90,349) to £22,256 (Scenario 2: £56,025 vs £74,364; Scenario 1: £79,843 vs £102,099), corresponding to a 11%-25% reduction. Savings are driven by lower fluid volume requirements, which decrease the number of bags and frequency of changes.
CONCLUSIONS: Selecting the appropriate citrate concentration in RCA and treatment modality can importantly affect hospital costs and operational efficiency. CVVHD protocols with medium citrate concentration can decrease hospital costs and nursing staff workload. Additional savings may result from less filter changes due to lower fluid volumes and different calcium infusion set-ups. TCO assessments can better evaluate treatment efficiencies, allowing more comprehensive, value-based procurement decisions beyond unit cost comparisons.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE576
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Urinary/Kidney Disorders