Estimations of Resource use, Costs, Clinical and Epidemiological Outcomes of Continuous and Intermittent Renal Replacement Therapies

GARAY, OU; PALACIOS, A; TAPIA-LOPEZ, E; HERNÁNDEZ-VÁSQUEZ, A; GARCIA MARTI, S; PICHON-RIVIERE, A; AUGUSTOVSKI, F; BARDACH, A

VALUE IN HEALTH

WILEY-BLACKWELL PUBLISHING, INC

Año: 2017 vol. 20

1098-3015

Objectives: To estimate resource use, costs, clinical and epidemiological outcomes associated to the treatment of Acute Kidney Injury (AKI) at Intensive Care Unit (ICU) with Continue or Intermittent Renal Replacement Therapies (CRRT or IRRT) in Argentina to feed a Cost-Effectiveness (CE) model that compares long-term economic and health outcomes. Methods: After validation of model and assumptions with local experts, a list of parameters where defined. The perspective was stated as of the insurance for the elderly (PAMI). Costs of daily CRRT, IRRT, Dialysis Dependence (DD) and Independence (DI) were estimated using a macro-costing approach, in ARS 2017. Clinical and epidemiological parameters were obtained from a review of studies indexed in PubMed, Cochrane Library, EMBASE, LILACS and relevant grey literature. Epidemiological parameters were survival rates at days 0, 60 and 180 and for DD at 90 and 1,095 from hospital discharge. Quality-of-life weights included were AKI patients at UTI, with DD and DI; Length of Stay (LoS) in ICU; therapy duration and percentage of patients switching from CRRT to IRRT. Results: Costs of daily CRRT, IRRT, DD and DI were $7,066.8, $1,963.0, $766.3 and $3.4 respectively. Survival at days 0, 60 and 180 were 0.655, 0.46 and 0.37 respectively for both therapies. DD at 90 and 1,095 days were 0.164 and 0.217 for CRRT and 0.208 and 0.266 for IRRT. LoS in ICU and therapy duration were 12.0 and 7.0 for both therapies and the switch of therapies 33.8%. ConClusions: No local-relevant literature was found. Evidence suggests no difference in survival rates, nevertheless the DD appears to be lower in CRRT than in IRRT. Daily costs of CRRT resulted higher than IRRT. This results will be used in the next phase, after a validation with a local expert panel, to derive CE results in Argentina, and can be extended to other countries in the region.